Page 178 - Ebook health insurance IC27
P. 178
The Insurance Times
Payment duration analysis - l Amount of claim for each age band
Claims settled monthly, l Analyse frequency and severity of claims in
quarterly, yearly
IBNR analysis different age bands
Claim analysis by geographical location
Diagnosis grouping and l Area in which most claims occur
provider network analysis l The area where most diseases occurs
l Which areas have high health care costs
l Identify high cost location and revise sales and
rating strategies
Claim analysis by hospitals
l Amount paid to each hospitals for claims
l Number of claims from each hospital
l Reason of high claims from particular hospital
l Identify high cost hospital and renegotiate terms
Analysis of claims helps in cash flow planning and
identifying settlement period of claims.
l Reserving for claims which are incurred but not
reported at the end of the accounting period
l Carry out different types of IBNR analysis
l Help the insurer to estimate its reserves
appropriately
l quality and efficiency of service providers
l type of diagnosis, period of stay in hospital and
cost of service provided by a them
l identifying major disease group, the frequency and
cost of treatment by provider
182 Guide for Health Insurance
