By: Cheryl Demars

 

Last week we sent a letter to the Wisconsin Congressional Representatives in the United States House and Senate to reiterate our priorities as they continue with plans for health care reform.  While the Massachusetts Senate election has added more uncertainty to the prospects for health care reform, we felt it was timely and important to remind our representatives of our priorities:

 

First and foremost, expanding coverage must be coupled with real strategies to control costs and maintain or improve quality (value). Beyond that,

You may also read the complete letter here.

 

As health care reform efforts continue in the next few months, we will continue to keep members as up-to-date as possible.

 

Two new books from the nonprofit International Foundation of Employee Benefit Plans (IFEBP) may serve as great resources for those looking for more ways to implement or improve their employee wellness program:

Also, a new report from the Wellness Council of America, Implementing Wellness Programs in Small Business Settings, targets employee wellness in small-business settings. The two-part report examines commonalities between successful wellness programs at businesses that employ less than 50. Included is a list of 10 key activities to get a small-business wellness plan off the ground. This free PDF report is available online (e-mail registration required).

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Claims Repricing
Our contracts require that we reprice claims we receive from providers and send them on to the claims administrator within three business days. In 2009, we averaged 0.01 days for electronic claims and 1.76 days for paper claims, for a total average turnaround of 0.43 days for all claims.

 

The majority of our claims are filed electronically through our electronic data interchange (EDI):

Call Volumes
Our customer service team experienced an increase in the number of telephone inquiries in 2009 from 2008. Calls from providers represent 67 percent of all the calls received by our customer service staff in 2009, with enrollees 27.92 percent, TPAs, others and employers making up the rest.

 

Three of the top five inquiries from all sources continue to be items that are best addressed by TPAs, not The Alliance, representing over 50% of the calls directed to our Customer Service department.  These include initial claims status (35.06%), question about benefits (11.4%), and eligibility verification (9.8%), which are then forwarded on to the TPA.

 

Our increased EDI connectivity with TPAs appears to be positively impacting claims forwarding efficiency as fewer provider calls are related to claims not received by TPA. It is no longer one of the top five reasons for provider inquiries.

 

Aerial Company Inc. has also recently joined The Alliance. A family business with roots dating back nearly 100 years, Aerial Company Inc. is a wholesale distributor of professional salon products. The business is headquartered in Marinette, Wis., and boasts 80 sales locations across 11 states. Aerial Company Inc. also prides itself on a commitment to continued training in hairstyling, coloring and manicure techniques, scheduling nearly 2,000 onsite programs for its customer salons each year.

 

Carol Mandernach has joined The Alliance as contract analyst in our provider relations department. Carol brings nearly nineteen years of health care experience in reimbursement and analysis, specializing in Medicare facility reimbursement and data modeling of hospital and physician contracts. As a contract analyst, Carol will support The Alliance's contracting efforts and work with Wisconsin Health Information Organization (WHIO) data.

 

Daniel Lehnherr has joined The Alliance as communications and Web specialist in our marketing and member services department. He brings six years experience in writing, design and Web work from positions in the public relations, newspaper, and advertising industries. In his role here at The Alliance, Daniel will be responsible for the design and content of the Web site as well as analyzing usage statistics and developing strategies to increase page views and site visitors. He will also manage the format, design and distribution of electronic and print materials for The Alliance, including the design of this newsletter.

 

Please join us in welcoming Carol, 800.223.4139, x 6653 and Daniel, 800.223.4139 x 6634.

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The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.

 

Just a reminder: Always check the online provider directory for the most current provider information!

 

 

The Alliance released our QualityCounts™ Inpatient Hospital Report a few months ago. The report was released in an e-book format, which like a PDF makes the report digital.

 

This QualityCounts for Employees piece helps individuals with access to The Alliance network understand how to navigate through the report. Members can print it out and share with employees so they will access the QualityCounts report next time they are making a decision about inpatient or outpatient care.

 

The Alliance highlights health care and benefit management news for employers in News You Can Use with a link to take you to the original story or report.

 

Survey: Per-employee Health Benefit Costs to Top $10,000
Want a Healthier Staff? Cash Incentives Work Best
A new survey predicts medical benefit expenditures will top $10,000 on a per-employee basis next year, and other research shows that financial incentives are the best way to get employees involved in valuable wellness programs. Read News You Can Use now.

 

Each month, The Alliance TPA Briefing delivers the latest news to third-party administrators about Alliance services, programs and events as well as information on health benefit trends, issues, and ideas of interest to our mutual clients.

 

Subscriptions are available on a complimentary basis. To subscribe, please send an e-mail message with your name and agency to the Marketing and Member Services Department.

 

Reader comments, suggestions, and topics are always welcome.

 

Cathy Lanser, Editor

Daniel Lehnherr, Design

Carlene Boehmer, Manager of Claims and Customer Service