Monthly Operations Report
ACHIA
Operations Report
March 2019
Alaska Comprehensive Health Insurance Association
Levels of Service
April 2018 - March 2019
Levels of
Service
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Enrollment Standards
1. 14-day Clean Application Process 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
2. 14-day ID Card Issuance 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
3. Accuracy 99% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Billing Standards
4. 14-day Paid-to Status Update 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
5. Accuracy 99% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Claims Standards
6. 30-day Clean Claim Process 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
7. Clerical Accuracy 97% 100% 100% 100% 100% 100% 100% 99.9% 100.0% 100% 100% 100% 100%
8. Financial Accuracy 98% 100% 100% 100% 100% 100% 100% 99.9% 99.9% 100% 100% 100% 100%
Customer Service Standards
9. 45 Sec. Speed of Answer* 45 sec avg 51 33 55 50 41 27 45 36 38 32 50 23
10. 5% Abandonment Rate* < 5% 0.9% 2.4% 3.2% 4.9% 4.2% 0.0% 0.9% 1.2% 1.3% 1.6% 2.0% 0.8%
* Reporting began January 1, 2007
Measurement of Standards
Standard 1 - If the date received compared to the date approved for all clean applications approved during the reporting month is less than 14-days.
Standard 2 - If the date received compared to the date mailed for all applications approved during the reporting month is less than 14-days from receipt of eligible application to
issuance of identification card.
Standard 3 - 99% or greater accuracy rate for enrollment coding of premium, plan and age rate categories for all approved applications during the reporting month.
Standard 4 - 100% scoring of (10) member audit of 14-calendar days or less from premium receipt to update of eligibility file paid-to-status
Standard 5 - 99% scoring of (10) member audit of accuracy for posting of correct payment, implementation of rate changes and premium account reconciliations during the
reporting month.
Standard 6 - 100% of clean claims processed within 30-calendar days during the reporting month.
Standard 7 - 97% or greater accuracy of a (20) claim audit for proper clerical coding of claims during the reporting month.
Standard 8 - 98% or greater accuracy of a (20) claim audit for proper clerical coding of claims during the reporting month.
Standard 9 - 45 second or less average speed of answer for all telephone inquiries received during the reporting month.
Standard10 - 5% or less call abandonment rate.
1
Alaska Comprehensive Health Insurance Association
Number of Claims Received
April 2018 - March 2019(as compared to Previous Year)
0
100
200
300
400
500
600
700
800
Apr-17
Apr-18
May-17
May-18
Jun-17
Jun-18
Jul-17
Jul-18
Aug-17
Aug-18
Sep-17
Sep-18
Oct-17
Oct-18
Nov-17
Nov-18
Dec-17
Dec-18
Jan-18
Jan-19
Feb-18
Feb-19
Mar-18
Mar-19
2
Alaska Comprehensive Health Insurance Association
Service Code Analysis*
For the Month of March 2019
Submitted PPO or Other Deductible Coinsurance Total Claim
Code Description Charge Discount Ineligible Amounts Amounts Paid Lines
ANCILLARY CHARGES 225,547.48$ 4,350.07$ 207,049.66$ 1,729.26$ 400.36$ 12,018.13$ 158
AMBULANCE 1,734.34$ 520.30$ -$ -$ -$ 1,214.04$ 2
PART B CO-INSURANCE 6,590,666.35$ 39.30$ 6,531,380.30$ -$ -$ 59,246.75$ 2
CHIROPRACTIC 1,570.00$ -$ -$ 432.18$ 227.56$ 910.26$ 869
DIAGNOSTIC TESTING 18,686.67$ 1,630.01$ 4,300.97$ 930.99$ 947.51$ 10,877.19$ 32
ER PHYSICIAN 1,050.00$ 21.00$ -$ -$ -$ 1,029.00$ 109
EQUIPMENT 969.74$ 67.60$ 260.86$ 32.88$ -$ 608.40$ 6
EMERGENCY ROOM 631.22$ 31.57$ -$ -$ 119.93$ 479.72$ 9
HOME HEALTH MISC. 3,000.00$ 780.00$ -$ -$ 444.00$ 1,776.00$ 7
INJECTIONS 752.00$ 43.76$ 457.97$ -$ 46.65$ 203.62$ 6
IMMUNIZATIONS 95.00$ 21.47$ -$ -$ -$ 73.53$ 3
MISC CHARGES 10,630.56$ 87.50$ 4,337.77$ 968.21$ 1,006.13$ 4,230.95$ 26
M/N OUTPATIENT 310.00$ 9.30$ -$ -$ 150.35$ 150.35$ 1
OFFICE VISIT 5,352.79$ 336.58$ 1,026.91$ 986.11$ 275.95$ 2,727.24$ 1
PRESCRIPTION DRUGS 75,349.48$ -$ -$ 3,110.84$ 7,143.90$ 65,070.77$ 1
SURGERY 6,353.08$ 45.25$ 5,163.81$ 61.74$ 15.14$ 1,067.14$ 3
UB ANESTHESIA 3,969.00$ 1,091.47$ -$ -$ -$ 2,877.53$ 320
UB DIAG TESTING 5,951.46$ 1,538.34$ -$ -$ -$ 4,413.12$ 19
UB PHYSICAL THERAPY 660.00$ 181.50$ -$ -$ -$ 478.50$ 78
UB SURGERY 19,845.00$ 5,457.38$ -$ -$ -$ 14,387.62$ 2
UB CANCER THERAPIES 3,517.81$ 967.40$ -$ -$ -$ 2,550.41$ 2
WELLNESS EXAM 216.00$ 10.80$ -$ -$ -$ 205.20$ 1
TOTALS 6,976,857.98$ 17,230.60$ 6,753,978.25$ 8,252.21$ 10,777.48$ 186,595.47$ 1,657
* Represents claims adjudicated in the month. May not tie to the financials depending on the timing of voids and adjustments.
3
Alaska Comprehensive Health Insurance Association
Service Code Analysis Year to Date
January - March 2019
Submitted PPO or Other Deductible Coinsurance Total Claim
Code Description Charge Discount Ineligible Amounts Amounts Paid Lines
ANCILLARY CHARGES 1,032,999.34$ 45,448.53$ 740,188.07$ 3,345.87$ 1,466.75$ 242,550.12$ 185
AMBULANCE 2,768.34$ 520.30$ -$ -$ -$ 2,248.04$ 4
ANESTHESIA 2,702.00$ 187.50$ 1,380.48$ -$ -$ 1,134.02$ 2
PART B CO-INSURANCE 15,532,041.24$ 51.72$ 15,316,003.34$ -$ -$ 215,986.18$ 1,341
CHIROPRACTIC 4,863.00$ -$ 8.00$ 1,692.18$ 257.56$ 2,905.26$ 49
DIAGNOSTIC TESTING 68,158.91$ 6,370.52$ 19,174.10$ 1,273.67$ 4,113.42$ 37,227.20$ 149
ER PHYSICIAN 6,582.00$ 163.16$ -$ 1,346.38$ 552.47$ 4,519.99$ 7
EQUIPMENT 969.74$ 67.60$ 260.86$ 32.88$ -$ 608.40$ 6
EMERGENCY ROOM 11,315.42$ 1,462.11$ -$ -$ 1,278.73$ 8,574.58$ 12
HOME HEALTH MISC. 18,375.00$ 5,336.25$ -$ 1,731.30$ 1,156.14$ 10,151.31$ 9
INJECTIONS 6,228.10$ 908.53$ 457.97$ -$ 157.90$ 4,703.70$ 9
IMMUNIZATIONS 484.38$ 68.28$ -$ -$ -$ 416.10$ 5
MISC CHARGES 29,787.14$ 274.54$ 11,319.94$ 5,213.70$ 1,462.39$ 11,516.57$ 39
MAMMOGRAM 207.00$ 10.35$ -$ -$ 39.33$ 157.32$ 1
M/N OUTPATIENT 495.00$ 9.30$ 168.82$ 16.18$ 150.35$ 150.35$ 2
MULTIPLE SURGERY 1,900.00$ 1,045.00$ -$ -$ -$ 855.00$ 1
OFFICE VISIT 24,389.94$ 1,263.26$ 5,015.56$ 3,506.85$ 973.97$ 13,630.30$ 79
PHYSICAL THERAPY 470.03$ -$ 447.73$ 22.30$ -$ -$ 1
RX MEMBER REIMBURSE 1,245.02$ -$ -$ -$ 210.74$ 1,034.28$ 3
PRESCRIPTION DRUGS 197,422.82$ -$ -$ 38,654.00$ 18,304.26$ 140,418.05$ 493
SURGERY 33,831.95$ 3,078.75$ 14,881.34$ 4,227.91$ 828.54$ 10,815.41$ 25
UB ANESTHESIA 3,969.00$ 1,091.47$ -$ -$ -$ 2,877.53$ 1
UB DIAG TESTING 26,766.81$ 4,595.99$ -$ 520.72$ 2,184.54$ 19,465.56$ 93
UB SPEECH THERAPY 884.00$ 214.46$ -$ -$ 133.90$ 535.64$ 2
UB PHYSICAL THERAPY 660.00$ 181.50$ -$ -$ -$ 478.50$ 2
UB SURGERY 19,845.00$ 5,457.38$ -$ -$ -$ 14,387.62$ 2
UB CANCER THERAPIES 3,517.81$ 967.40$ -$ -$ -$ 2,550.41$ 2
UB PULMONARY REHAB 454.00$ 110.14$ -$ -$ 68.77$ 275.09$ 2
WELLNESS EXAM 576.00$ 10.80$ -$ -$ -$ 565.20$ 2
WELLNESS TESTING 465.00$ 20.26$ -$ -$ -$ 444.74$ 3
TOTALS 17,034,373.99$ 78,915.10$ 16,109,306.21$ 61,583.94$ 33,339.76$ 751,182.47$ 2,531
4
Alaska Comprehensive Health Insurance Association
Top Provider Report For the Month of
March 2019
RANK DESCRIPTION
# OF
CLAIMS
SUBMITTED
CHARGES PAID BY PLAN
1 PROVIDENCE HEALTH & SERVICES WASHINGTON 30 $ 286,329.05 40,567.05$
2 DENALI DIALYSIS 17 $ 1,979,054.69 13,429.36$
3 LIBERTY DIALYSIS ALASKA 16 $ 2,533,473.92 12,676.68$
4 DIALYSIS ASSOCIATES OF ALASKA 39 $ 64,861.00 7,488.06$
5 IMAGING ASSOCIATES LLC 1 $ 5,772.08 5,483.48$
6 FRANKLIN E ELLENSON MD 9 $ 85,515.00 3,643.05$
7 FRESENIUS MEDICAL CARE SOUTHWEST 5 $ 369,612.30 3,127.13$
8 BOND PHARMACY INC 3 $ 6,940.00 2,371.20$
9 ALASKA RADIOLOGY ASSOCIATES 14 $ 3,670.00 2,025.05$
10 PROVIDENCE IMAGING CENTER 4 $ 8,755.00 1,952.06$
11 SOUTHEAST ALASKA REG HLTH CONS 1 $ 3,137.85 1,819.76$
12 RENAL CARE GROUP WASILLA LLC 2 $ 221,006.13 1,785.79$
13 ALASKA UROLOGY LLC 6 $ 18,200.75 1,733.56$
14 ALASKA HOSPITALIST GROUP LLC 22 $ 35,813.00 1,583.58$
15 GALEN HOSPITAL ALASKA INC 5 $ 2,133,368.65 1,452.31$
16 ST LUKES REGIONAL MEDICAL CTR 2 $ 24,820.90 1,386.69$
17 LIFEMED ALASKA LLC 1 $ 1,734.34 1,344.11$
18 FRESENIUS MED CARE SOLDOTNA 2 $ 115,605.17 1,249.26$
19 DENALI EMERGENCY MEDICAL ASSOC 3 $ 3,414.00 1,085.42$
20 KIDNEY AND HYPERTENSION CLINIC 42 $ 31,159.00 1,077.38$
21 LIBERTY DIALYSIS HAWAII LLC 2 $ 143,973.82 1,059.45$
22 ORTHOALASKA LLC 3 $ 30,643.00 992.98$
23 PAIRMORE & YOUNG SYNERGY CHIRO 13 $ 1,305.00 910.26$
24 RENAL CARE GROUP ALASKA INC 2 $ 207,289.28 897.00$
25 ANCHORAGE NEIGHBORHOOD HEALTH 5 $ 1,211.00 857.82$
26 EDWIN RHIM MD 1 $ 1,131.00 685.30$
27 FAIRBANKS MEMORIAL HOSPITAL 3 $ 1,536.82 560.40$
28 PROVIDENCE ANCHORAGE ANESTHESIA 5 $ 11,726.00 527.92$
29 PROVIDENCE CONTINUING CARE SERVICES 1 $ 8,111.24 511.50$
30 ANDRZEJ R MACIEWSKI MD 2 $ 624.74 499.94$
Top 30 Total 261 8,339,794.73$ 114,783.55$
5
RANK DESCRIPTION
# OF
CLAIMS
SUBMITTED
CHARGES PAID BY PLAN
1 RENAL CARE GROUP ALASKA INC 33 1,872,216.60$ 236,941.30$
2 PROVIDENCE HEALTH & SERVICES WASHINGTON 80 1,147,736.53$ 60,661.92$
3 ST ELIAS SPECIALTY HOSP 1 702,356.16$ 45,895.00$
4 LIBERTY DIALYSIS ALASKA 45 5,947,467.42$ 31,774.38$
5 DENALI DIALYSIS 38 3,667,571.19$ 20,810.12$
6 DIALYSIS ASSOCIATES OF ALASKA 102 166,375.00$ 17,618.28$
7 FAIRBANKS MEMORIAL HOSPITAL 24 84,486.88$ 14,238.08$
8 BOND PHARMACY INC 10 22,630.00$ 11,838.51$
9 IMAGING ASSOCIATES LLC 9 18,222.88$ 10,730.25$
10 RENAL CARE GROUP WASILLA LLC 15 1,272,653.07$ 10,007.38$
11 MEDICAL GROUP OF ALASKA 12 27,800.00$ 9,496.39$
12 FRANKLIN E ELLENSON MD 25 205,995.00$ 7,526.33$
13 ALASKA HEART INSTITUTE LLC 45 51,954.50$ 7,380.42$
14 ADL INC 4 8,900.00$ 6,269.94$
15 FRESENIUS MEDICAL CARE SOUTHWEST 17 1,292,234.02$ 6,190.58$
16 GALEN HOSPITAL ALASKA INC 12 2,346,477.32$ 6,112.01$
17 PROVIDENCE IMAGING CENTER 15 26,470.00$ 4,775.68$
18 GENEVA WOODS PHARMACY INC 1 5,142.58$ 4,564.05$
19 PROVIDENCE CONTINUING CARE SERVICES 2 76,565.46$ 4,364.00$
20 FRESNIUS MEDICAL CARE 7 683,646.49$ 3,999.61$
21 CLARIBEL TAN 7 3,606.00$ 3,576.00$
22 HAWAII LIFE FLIGHT LLC 3 126,848.40$ 3,446.64$
23 ALASKA RADIOLOGY ASSOCIATES 46 35,444.00$ 3,438.23$
24 ALASKA SURGERY CENTER A HEAL 1 7,742.66$ 3,352.31$
25 ALASKA HOSPITALIST GROUP LLC 54 70,404.00$ 3,301.10$
26 KIDNEY AND HYPERTENSION CLINIC 138 91,512.00$ 3,220.65$
27 EDWIN RHIM MD 11 8,417.30$ 3,215.61$
28 FRESENIUS MED CARE SOLDOTNA 8 467,930.16$ 3,198.18$
29 REHABILITATION MEDICINE ASSOCI 6 1,647.00$ 3,155.25$
30 ALASKA UROLOGY LLC 16 26,746.75$ 2,712.69$
Top 30 Total 787 20,467,199.37$ 553,810.89$
Alaska Comprehensive Health Insurance AssociationTop Providers Year to Date
January - March 2019
6
Alaska Comprehensive Health Insurance Association
Average Cost Per Non Medicare Plan Claim Paid
April 2018 - March 2019
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
$1,000 Deductible $1,500 Deductible $2,500 Deductible $5,000 Deductible $10,000 Deductible $15,000 Deductible $1,000 Std Deductible
7
Alaska Comprehensive Health Insurance Association
Average Cost Per Medicare Plan Claim Paid
April 2018 - March 2019
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Carveout Med Supp A Med Supp I Med Supp F
8
Alaska Comprehensive Health Insurance Association
PPO Savings Analysis
April 2018 - March 2019
PPO Network Charge PPO Discount % of Discount
First Choice Health Network 5,346,292$ 898,294$ 16.8%
9
Month / Year Case Provider Total Billed Total Paid
Total
OOP
Date of
Service
Date
Received Date Paid Primary Diagnosis
April 2018 None
May 2018 None
June 2018 None
July 2018 None
August 2018 None
September 2018 None
October 2018 None
November 2018 None
December 2018 None
January 2019 None
February 2019 None
March 2019 None
12 Month Average
Amount Billed: $0.00
12 Month
Average
Amount Paid: $0.00
Alaska Comprehensive Health Insurance Association (ACHIA)High Dollar Paid Claims Report
April 2018 - March 2019
Includes claims with paid amounts ≥ $100,000
10
Alaska Comprehensive Health Insurance Association
Plan Age Distribution Summary
March 2019
Traditional Plan
Age Carveout Med Supp A Med Supp I Med Supp F Age $1,000 Age $1,000 $1,500 $2,500 $5,000 $10,000 $15,000
0-17 0 0 0 0 0-17 0 0-17 0 0 0 0 0 018-29 0 0 0 0 18-29 0 18-29 0 0 1 0 0 0
30-34 0 0 0 2 30-34 2 30-34 0 0 0 0 0 0
35-39 0 0 0 2 35-39 0 35-39 2 0 0 0 0 0
40-44 1 0 0 0 40-44 0 40-44 0 0 0 1 0 0
45-49 1 0 0 0 45-49 0 45-49 0 0 3 0 1 0
50-54 2 1 0 6 50-54 0 50-54 0 0 1 4 0 0
55-59 2 1 0 12 55-59 2 55-59 0 0 1 1 1 2
60-64 5 1 0 23 60-64 1 60-64 1 0 3 1 2 1
65-69 0 0 0 12 65-69 0 65-69 0 0 0 0 0 0
70-74 0 2 0 9 70-74 0 70-74 0 0 0 0 0 0
75-79 0 1 0 4 75-79 0 75-79 0 0 0 0 0 0
80-84 0 0 0 3 80-84 0 80-84 0 0 0 0 0 0
85+ 0 0 1 1 85+ 0 85+ 0 0 0 0 0 0
Total 11 6 1 74 Total 5 Total 3 0 9 7 4 3
123
.
;
TOTAL ENROLLMENT:
Medicare Plans PPO Plans
0
10
20
30
40
50
60
70
80
11 6
1
74
5
3 0
9 7 4 3
Carveout Med Supp A Med Supp I Med Supp F Traditional $1,000 Plan $1,500 Plan $2,500 Plan $5,000 Plan $10,000 Plan $15,000 Plan
11
Alaska Comprehensive Health Insurance Association
Total Enrollment Activity
April 2018 - March 2019
125133
135130 132
128 128126
128 129 130
123
0
50
100
150
200
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
12
Alaska Comprehensive Health Insurance Association
Enrollment Activity by Plan - Non Medicare Plans
April 2018 - March 2019
0
5
10
15
20
25
30
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
A $1000 Deductible B $1,500 Deductible C $2,500 Deductible D $5,000 Deductible
E $10,000 Deductible F $15,000 Deductible $1,000 Std Deductible
13
Alaska Comprehensive Health Insurance Association
Enrollment Activity by Plan - Medicare Plans
April 2018 - March 2019
0
10
20
30
40
50
60
70
80
90
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Carveout Med Supp A Med Supp I Med Supp F
14
Alaska Comprehensive Health Insurance AssociationEnrollment Activity
March 2019
Month Start Adds
Pended
Adds* Terms
Retro
Terms** End Net Change
Apr-18 122 4 1 1 - 126 4
May-18 126 7 1 - 1 133 7
Jun-18 133 5 - 2 6 130 (3)
Jul-18 130 - - 1 1 128 (2)
Aug-18 128 5 - 1 2 130 2
Sep-18 130 - 1 2 1 128 (2)
Oct-18 128 1 - 1 1 127 (1)
Nov-18 127 2 1 3 2 125 (2)
Dec-18 125 3 - 1 1 126 1
Jan-19 126 3 - - 2 127 1
Feb-19 127 2 - - 5 124 (3)
Mar-19 124 1 - 2 - 123 (1)
563 80 656 387
Enrollment is reported by month of initial effective coverage.
* Pended Adds represent pended applications that were approved in the reporting month but have a prior effective date.
These enrollees are reported in the row representing initial effective coverage date.
**Retro Terms represent terminations that were processed in the reporting month but have a prior termination date.
These terminations are reported in the row representing the actual month of the termination.
Count Percent Mar-19
Pended
Adds*
132 21% - -
130 20% - -
297 46% 1 -
83 13% - -
642 100% 1 -
Count Percent Mar-19
Retro
Terms**
7 1% - -
18 2% - -
42 4% - -
2 0% - -
146 14% 1 -
47 5% - -
92 9% - -
336 32% 1 6
345 33% - -
1,035 100% 2 6
Too costly
Deceased
Totals since June 2011
Qualifying Event Reasons (data from 6/1/11 - 3/31/19)No other health insurance - HIPAA eligible
Rejection of other health coverage due to pre-existing condition
Pre-qualified health conditions on the list
Medicare / Medicaid
Moved out of state
Unknown - Letter sent to request reason for termination
Non-payment
Obtained other coverage
Total
Lifetime Max
Reinstated
Total
Termination Reasons (data from 6/1/11 - 3/31/19)Free look period
15
Alaska Comprehensive Health Insurance Association
Plan Age Distribution - NEW ENROLLMENT
March 2019
Traditional Plan
Age Carveout Med Supp A Med Supp I Med Supp F Age $1,000 Age $1,000 $1,500 $2,500 $5,000 $10,000 $15,000
0-17 0-17 0-1718-29 18-29 18-29
30-34 30-34 30-34
35-39 35-39 35-39
40-44 1 40-44 40-44
45-49 45-49 45-49
50-54 50-54 50-54
55-59 55-59 55-59
60-64 60-64 60-64
65-69 65-69 65-69
70-74 70-74 70-74
75-79 75-79 75-79
80-84 80-84 80-84
85+ 85+ 85+
Total 1 0 0 0 Total 0 Total 0 0 0 0 0 0
1
(Not included in New Enrollment count)
Medicare Plans PPO Plans
TOTAL NEW ENROLLMENT:
REINSTATEMENTS: 0
16