Page 192 - Ebook health insurance IC27

The Insurance Times

of claims settled by the end of each month in proportion to the total number of
claims paid upto the end of the year. The analysis of claims paid with the duration
of payment help to plan the cash flow and identify the settlement period of claim.
This analysis, if done by type of claims, hospitals and cities can provide better
reasons for the settlement delays.

(h) IBNR Analysis - These are the claims incurred, but not repeated by the end of
the accounting period. There are four types of analysis that can be done on the
data for IBNR analysis. The first and second analysis show the development of
incremental payments by the month ofpayment and the development of cumulative
payments for each month. The third analysis will show percentage completion of
payments, based on selected factors, by the end of corresponding number of
months for each claim occurrence. The fourth analysis show the completion factors
for different methods and the selected completion factors.

This IBNR analysis help an insurer estimate its reserves appropriately and to
estimate the full incurred claims for any time period under study. It is used in rating
and trend analysis and every other special ad hoc analysis of claims expense
undertaken by the insurer, and assists the insurer in filing the annual liability report
with the Regulator.

(i) Diagnosis Grouping and Provider Network Analysis - This analysis show the
quality and efficiency of various health care providers. The claim data can be
analyzed by the type of diagnosis, period of stay in the hospital and the cost of
service provided by them. This analysis can help to identify the major disease
group, their claim frequency and the cost of treatment by provider, to ascertain
the quality of care and the fairness of rates charged by the providers. This help to
avoid misuse and frauds contracted by the provider network.

196 Guide for Health Insurance