STUDENT HEALTH INSURANCE ADVISORY COMMITTEE … · UHCSR.com Web-X presentation . Terri Bradford with UHCSR provided a webinar presentation of the upgraded website. ... HealthiestYou

STUDENT HEALTH INSURANCE ADVISORY COMMITTEE

Information for September 6, 2017

AGENDA

Kansas Board of Regents Student Health Insurance Committee

Kansas Board of Regents Board Room Wednesday, September 6, 2017 at 12:30 p.m.

I. Approve: Minutes from the May 3, 2017 meeting

II. Utilization Summary – review UHC’s new Client Reporting draft A. Demographics by policy type will be included in future versions B. Discuss other changes/additions for the Utilization Summary

III. UHC Waiver Audit Services A. UHC report about the new ECI waiver process B. University perspectives about the ECI waiver process and what the student and

administrative response/reaction has been IV. Good of the Order V. Future SIAC meeting tentatively scheduled for 12:30, KBOR Board Room

A. Wednesday, December, 6, 2017 B. Wednesday, February 7, 2018

KANSAS BOARD OF REGENTS

Student Insurance Advisory Committee MINUTES

May 3, 2017 The March 1, 2017 meeting of the Student Insurance Advisory Committee (SIAC) was called to order at 12:30 p.m. Members in Attendance: Doug Ball, COBO (Chair) Diana Malott, KU Mary McDaniel, ESU Sheryl McKelvey, WSU Madi Vannaman, KBOR Members Participating by Telephone: Valerie Noack, KUMC Jim Parker, KSU Carol Solko-Olliff, FHSU Also present at the meeting was Theresa Schwartz, KBOR; Camille Childers, WSU; Chuck Olcese and Regina Sherrill, KU; Dale Burns, UHCSR; Lesley Gagnon, Mercer; and Laura Evans, ECI Services. Karen Kirk, PSU, was unable to attend but Vickie Mense and Rita Girt participated by phone in her place. Others participating by phone were Sharon Maike, KSU; Mary Karten, KU; Lynn Adams, FHSU; Alex Harkins, KMC; Matt Brinson, UHCSR; Jennifer Dahlquist, MHEC; and Liz Marks, Mercer. KU student members Kamen Kossow and Abdoulie Njai were unable to attend. Minutes The minutes from the March 1, 2017, meeting were approved. UHCSR.com Web-X presentation Terri Bradford with UHCSR provided a webinar presentation of the upgraded website. Each campus was provided the beta website to review and were instructed to send any changes to Heather Lewis. Mercer Utilization Report Liz Marks reviewed information in the utilization report. A correction was made to page 1, the second bullet: “The paid loss ratio increased from 62.2% to 62.3%.” Matt Brinson confirmed that the annualized enrollment count of students was correct stating that the 3G enrollment included international and domestic students. Dale Burns said that for the September 2017 meeting, the PY 16-17 count should be final and PY 15-16 counts would also be provided. BetterHelp Service Dale Burns stated that in looking to identify the most appropriate place for a student to get care, UHC developed an initiative because emergency rooms are being highly utilized and that drives up costs for students and the health plan and drives up premiums. HealthiestYou is a student branded tele-medicine service for non-emergent care when the health center is not readily accessible. This program was not included in the PY 17-18 KBOR plan, as it was brought up late, but UHC would like to suggest that KBOR include Healthiest You for 17-18. A call-in number would be set up so when the student calls when the health center is open, the student would be instructed to go there or the call could be routed to the health center. For one UHCSR plan, with 5,000 insured, 16 students registered and none actually used the service. As health centers are actively promoted, it will take several years for the students to adopt it.

Student Insurance Advisory Committee May 3, 2017 Page 2 BetterHelp is working through the issues about what can be reported back to the university and to what entity information should be shared, Dale Burns recommends delaying implementing that product. But, he recommends that KBOR universities consider the virtual doctor visit aspect, for non-emergent care, when the health center is closed. Diana Malott stated that when previously discussed, HealthiestYou (aTeledoc company) had no mechanism to report contacts back to the health center. The current after hours help line faxes actual encounter notes for prior night’s contacts that enables follow up with students. Dale Burns stated that today HealthiestYou does not have that feature but they are looking at potentially using the transition of care regulations to identify the contact as initial care from HealthiestYou that is transitioned to the health center. Diana Malott stated that 24/7 information would still be needed for students who do are not insured by UHC. Diana Malott was to provide a redacted encounter form to Dale Burns who stated that UHCSR would consider customizing scripts to be used when the health centers are actually closed and might group some universities together based on enrollment. [Update: After the meeting and upon further discussion with the Watkins Chief of Medical Staff, KU will not be utilizing HealthiestYou. Their concerns were potential confusion among students about who is or is not charged for a consultation, the lack of information on the prescribed treatment to students, and the potential for associating the health center with concerns about treatment decisions made by HealthiestYou.] Jim Parker asked whether there was a mobile component to HealthiestYou for pricing of pharmacy services in the local community. Dale Burns responded that there is a whole suite of options including locate a pharmacy and get a price on a prescription, but UHCSR removed anything that would conflict with any existing benefits or services offered under the medical plan or at the Student Health Service. Now strictly a virtual doctor’s office visit is being used as a way to address students, after-hours, in a timely manner has been at the forefront. Dale Burns stated that if HealthiestYou was included in the plan, HealthiestYou has agreed to offer the service to any student enrolled at the university at no charge, except for the per fee charge when the call is made. It would be embedded in all plans, so when member calls there is no payment requirement and nothing is charged to the plan. If the student is not enrolled in UHC, they can still get a $40 doctor’s visit, and will have the same services as any student who is ensured. Liz Marks asked what services are provided on the behavioral health side. Dale Burns stated that Better Help manages encounters for a fee offering multi-platforms by which the student can interact. There is a $200 month charge for unlimited encounters and no preset charge per encounter. There is no structure to offer this to non-insured students nor a way to limit the number of encounters provided. Counselors are licensed in each state they provide services to. Dale Burns stated he will continue providing information for discussion with the goal to include the product in PY 18-19 if possible. Jim Parker asked if additional information could be provided and Dale Burns stated he will provide an FAQ and much condensed marketing materials. UHC Waiver Audit Services Dale Burns introduced Laura Evans, with ECI Services, who provided information about the waiver audit services that can be performed on behalf of the KBOR universities.

Student Insurance Advisory Committee May 3, 2017 Page 3 Dale Burns stated that UHCSR is looking for ways to improve service it provides. As UHC is not in position to perform audits, because of potential conflict, they offer to include ECI Services at no cost to the plan. UHCSR projects that enrollment will increase because of management of the waiver process and there will be a decrease in work performed by the universities. Laura Evans provided information about the one-stop audit solution ECI Services would provide that is being utilized by 70 university clients with over 500,000 waiver audits performed for both domestic and international students. With the universities providing an eligibility list of international students, a customize email is sent to students with info about the KBOR plan that can include university logos and/or ECI logos. Students can positively enroll or the student can provide waiver information collected daily that can be worked through the entire enrollment period. Results can be communicated in back daily reports (who was denied, who is pending, who has successfully waive, who has done nothing), and premiums can be removed from student accounts by working with university programmers. The process can be seamless and easy and would take the administrative burden off the university. The waiver enrollment form requires information about the plan the student has, with a pull-down menu populated with various student health plans. If the plan is not ACA-compliant, an automatic email is sent to inform the student that the plan is not eligible for waiver. If the student has embassy or government sponsored coverage, the result will be based on the country and sometimes it will take weeks to receive appropriate documentation. Students who arrive late would also be included in the review. Eligible list can be updated daily, weekly, monthly – however often needed. Processes used by the campuses can differ. Information about those students who have waived will include their health plans with billing information that can be used by the health centers. The campuses can implement a customized appeals process, that would specify the types of appeals allowed (such as employer provided coverage), and the university can always make the final decision. Each university can decide whether to participate and how they wish to participate, including what information is provided. Regina Sherrill asked whether Saudi students, who represent approximately 42% of the waivers and most already have UHC coverage, could be automatically waived. Dale Burns stated that Saudi plans are no longer fully insured and he will check with UHCSR’s legal section to see if they can proactively provide information to the KBOR universities so those students would not be included in the waiver audit. [Update: After the meeting, in a May 5th email, Dale Burns provided this update: I received approval to implement (procedural details yet to be worked out) access by ECI to the Saudi Arabian Cultural Mission (SACM) Sponsored students that we cover here at UHCSR. This access will allow ECI to “audit” the coverage used by those students to waive off the school sponsored plan, verifying that they have adequate coverage. This access will expedite the process and also allow for better service to the school and students.] Sheryl McKelvey asked what happens to the data once the audit is complete and Laura Evans stated that the data is retained and stored in a highly HIPPA secure environment and access to that information is limited to three people within the organization. Sheryl McKelvey asked if the university opted to try the services for a semester and then decided it did not work well for them, could the service be discontinued, and Laura Evans replied yes.

Student Insurance Advisory Committee May 3, 2017 Page 4 Regina Sherrill asked whether the university still needed to send a list to UHCSR to activate the student’s plan? Laura Evans responded that the university could determine whether ECI Services or the university would provide the list to UHCSR and suggested that initially having the report provided to the university for review might work well to allow the university to gain a comfort level with the accuracy of the lists. Mary Karten stated that each university may have different requirements and with the individualized treatment could the setup be completed by August 1st and Laura Evans said that ECI Services is known for the speed and accuracy of implementation and recently set up 34 schools in three weeks time. The SIAC members will take the information back to their campuses and can reach out to Dale Burns and Matt Baker to opportunities to discuss the services further with Laura Evans. Good of the Order The Mercer team was thanked for their contributions to the KBOR student insurance plan. Diana Malott, Sheryl McKelvey and Lynn Adams agreed to review sample reports UHC will provide in July for reporting in the future. Future SIAC meetings Future SIAC meeting tentatively scheduled for 12:30, KBOR Board Room 1. Wednesday, September 6, 2017 2. Wednesday, December 6, 2017

Demonstration University

2016-17 School YearUtilization as of November 2016

Confidential Property of UnitedHealth Group. Recipient shall be liable for using and protecting from further disclosure or misuse, consistent with applicable law.

Client: Demonstration University - School Year: 2016 - Claims as of November 2016 - Report Execution Time: 8/24/2017 12:30:36 PM

2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Section Report

OverviewDemographics

Plan Experience

Claims Reports

Top 10 SR Charge Categories

Network Utilization by Charge

Large Claims

Provider ReportsProvider Network Experience

Top 20 Rendering Providers

Pharmacy Reports

Top 10 Rx Categories

Utilization by Tier

Three Year Detailed Utilization

Table of Contents



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Dependent % of Member Count

1%

Members Utilizing Rx

965

% Members Utilizing Rx

Total Members

3,598

Students

3,564

Spouses

25

Children

9

Student Dependent Ratio

~ 104 : 1

Gender Ratio %

M F

40% 60%

Male Students

1,408

Average Student Age

20

Female Students

2,156

Demographics by Age and Gender

Rx



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Plan Experience Overview



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Top 10 SR Charge Categories2016-17 School Year



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Network Utilization by SR Charge Category

2015-16 2016-17

Charge Type Charge Description Claims Claimed Deductible Paid Claims Claims Claimed Deductible Paid ClaimsInpatient-NonPreferred Provider

Total 40 $109,610 $4,472 $54,048 2 $318 $254 $0

HOSPITAL 20 $85,089 $1,024 $49,932 1 $15 $12 $0

PROFESSIONAL FEE 9 $11,759 $1,893 $2,567 1 $303 $242 $0

INPATIENT SURGERY 1 $3,803 $292 $933

PHYSICIAN VISITS 5 $1,502 $436 $287

PRESCRIPTIONS 3 $457 $105 $211

ASSISTANT SURGEON 1 $6,160 $448 $69

ANESTHETIST 1 $840 $275 $49

Inpatient-Preferred Provider

Total 331 $1,162,825 $3,520 $511,920 85 $307,434 $1,110 $149,312

HOSPITAL 145 $989,279 $1,744 $439,409 37 $263,682 $200 $126,745

INPATIENT SURGERY 17 $91,200 $365 $34,591 6 $21,592 $190 $12,391

PHYSICIAN VISITS 76 $33,335 $600 $17,024 24 $11,441 $200 $4,833

ANESTHETIST 16 $29,060 $69 $14,770 5 $6,983 $320 $4,454

HOME HEALTH CARE 2 $2,500 $0 $1,970

PROFESSIONAL FEE 73 $14,782 $741 $3,849 13 $3,736 $200 $889

ASSISTANT SURGEON 2 $2,669 $0 $306

Ledger Claims Total 18 $179,555 $20 $179,466 8 $53,235 $0 $53,212

SHC-INJECTIONS 2 $179,290 $0 $179,290 2 $53,120 $0 $53,120

SHC-DURABLE MED/BRACES/APPL 3 $40 $0 $28

SHC-LABORATORY 2 $65 $0 $52 1 $15 $0 $12

SHC-PHYSICIAN VISITS 10 $160 $20 $112 5 $100 $0 $80

SHC-ADJUSTMENTS 1 $0 $0 ($16)



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

2015-16 2016-17

Charge Type Charge Description Claims Claimed Deductible Paid Claims Claims Claimed Deductible Paid ClaimsNon Service Charges

Total 555 $380 $0 $13,321 13 $7 $0 $10

ADJUSTMENTS 457 $0 $0 $22,456 9 $0 $0 $3

CLAIM INTEREST 81 $315 $0 $315 4 $7 $0 $7

OTHER INSURANCE 14 $0 $0 ($7,055)

MEDICAL RECORDS 1 $56 $0 $56

STATE MANDATE TAX 1 $10 $0 $10

REFUNDS 1 $0 $0 ($2,460)

Other Charges Total 288 $125,491 $15,461 $51,131 70 $18,466 $3,626 $6,064

GROUP LEDGER BILLING 12 $0 $0 $0 7 $0 $0 $0

OTHER 15 $17,519 $0 $17,519 3 $283 $0 $283

DURABLE MED/BRACES/APPL 47 $24,137 $810 $7,757 13 $2,438 $197 $941

CONSULTANT 110 $37,821 $4,327 $16,388 29 $9,555 $1,824 $3,196

AMBULANCE 44 $27,648 $9,643 $9,006 7 $3,817 $1,136 $1,128

DENTAL 47 $16,690 $0 $0 7 $1,190 $0 $0

URGENT CARE 11 $1,677 $680 $461 3 $577 $269 $200

ABORTION 2 $0 $0 $0 1 $606 $200 $316

Outpatient-NonPreferred Provider

Total 1,056 $813,537 $66,231 $242,342 175 $103,666 $23,028 $21,964

RADIATION THERAPY 33 $62,129 $500 $28,776

PHYSICIAN VISITS 677 $348,063 $39,380 $136,338 129 $40,094 $16,801 $11,713

HOSPITAL 8 $40,100 $0 $20,176 3 $19,745 $448 $1,663

OUTPATIENT SURGICAL FACILITIES 10 $176,519 $2,211 $20,764 4 $26,103 $1,019 $4,952

ASSISTANT SURGEON 4 $22,743 $0 $4,139

LABORATORY 129 $55,446 $11,033 $12,690 20 $7,271 $1,820 $860

OUTPATIENT SURGERY 20 $55,534 $2,413 $5,019 3 $2,253 $367 $776

CAT SCAN / MRI 7 $9,114 $658 $2,369 1 $2,660 $500 $887

MEDICAL EMERGENCY 18 $18,500 $2,774 $5,752 1 $718 $150 $368

PHYSIOTHERAPY 89 $18,452 $4,473 $5,770 10 $3,507 $1,539 $546



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

2015-16 2016-17

Charge Type Charge Description Claims Claimed Deductible Paid Claims Claims Claimed Deductible Paid ClaimsOutpatient-NonPreferred Provider

ANESTHETIST 6 $7,409 $854 $1,677 1 $1,080 $367 $0

XRAYS 21 $6,838 $1,183 $1,840 1 $55 $17 $19

INJECTIONS 12 $1,110 $616 $240 2 $180 $0 $180

PRESCRIPTIONS 19 $644 $134 $306

SUPPLIES/MISC 2 $135 $0 $87

CHEMOTHERAPY 1 ($9,200) $0 ($3,599)

Outpatient-Preferred Provider

Total 23,423 $6,235,830 $330,500 $2,143,623 6,320 $1,535,664 $118,696 $498,451

PRESCRIPTIONS 14,240 $2,102,855 $129,154 $899,691 4,033 $626,958 $39,727 $268,039

OUTPATIENT SURGICAL FACILITIES 61 $475,138 $26 $198,089 12 $51,644 $14 $26,450

LABORATORY 3,168 $1,022,572 $21,895 $200,656 763 $289,191 $8,926 $50,206

PHYSICIAN VISITS 3,006 $734,698 $97,290 $255,117 747 $192,189 $40,177 $48,334

RADIATION THERAPY 4 $33,129 $0 $17,537

MEDICAL EMERGENCY 330 $413,603 $39,889 $107,298 75 $56,250 $9,937 $17,318

CAT SCAN / MRI 239 $427,290 $6,336 $102,659 47 $70,216 $2,122 $12,594

OUTPATIENT SURGERY 376 $248,130 $10,626 $90,748 104 $58,115 $5,303 $17,949

CHEMOTHERAPY 28 $138,516 $547 $55,455 2 $18,252 $400 $5,494

SUPPLIES/MISC 305 $121,047 $0 $42,582 88 $39,194 $0 $14,394

XRAYS 679 $211,460 $20,263 $66,381 167 $58,216 $8,362 $14,436

PHYSIOTHERAPY 614 $153,953 $3,161 $38,382 173 $47,200 $2,757 $9,563

INJECTIONS 316 $74,746 $911 $40,730 92 $11,306 $369 $6,694

ANESTHETIST 51 $63,763 $200 $26,825 17 $16,932 $600 $6,980

ASSISTANT SURGEON 5 $14,231 $0 $1,442

HOSPITAL 1 $700 $200 $31

Total 25,711 $8,627,228 $420,203 $3,195,851 6,673 $2,018,790 $146,715 $729,013



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

2015-16 2016-17

Cause Code Description Claims Claimed Deductible Paid Claims INN % OON % Claims Claimed Deductible Paid Claims INN % OON %A.I.D.S. 6 $1,285 $0 $418 100% 0% 3 $1,079 $51 $303 100% 0%

ALCOHOLISM 58 $23,503 $3,328 $7,739 97% 3% 17 $4,424 $817 $1,746 100% 0%

ALLERGY 101 $15,022 $1,702 $3,851 100% 0% 37 $6,066 $663 $2,000 100% 0%

CIRCULATORY SYSTEM 94 $55,890 $3,968 $14,923 90% 10% 15 $13,271 $865 $4,364 100% 0%

CONGENTIAL ANOMALIES 36 $49,471 $930 $25,531 100% 0% 2 $730 $0 $519 100% 0%

DENTAL 11 $13,240 $1,579 $3,195 20% 80% 1 $2,691 $200 $547 100% 0%

DIAGNOSTIC INFO UNAVAIL. 294 $141,353 $9,430 $68,079 95% 5% 68 $37,590 $3,222 $15,780 100% 0%

DIGESTIVE SYSTEM 267 $494,117 $10,775 $178,728 102% -2% 72 $92,669 $3,862 $27,313 100% 0%

DISEASES OF THE BLOOD 40 $9,368 $741 $3,698 100% 0% 6 $30,138 $320 $19,637 100% 0%

DRUG ABUSE 79 $239,344 $1,467 $81,968 15% 85% 100% 0%

ELECTIVE ABORTIONS 100% 0% 1 $606 $200 $316 100% 0%

ENDOC/NUTRIT/METAB/IMMUN 183 $73,605 $5,524 $21,333 83% 17% 38 $20,482 $2,283 $2,785 75% 25%

FOREIGN BODY/BURNS 8 $5,147 $1,200 $1,370 100% 0% 5 $2,350 $467 $447 100% 0%

FRACTURES/DISLOCATIONS 171 $323,333 $7,203 $112,925 80% 20% 40 $82,569 $3,334 $26,079 98% 2%

GENITOURINARY SYSTEM 711 $511,033 $21,503 $144,351 98% 2% 173 $128,693 $7,898 $46,542 100% 0%

GROUP LEDGER BILLING 24 $199,849 $0 $196,809 0% 100% 7 $53,573 $0 $53,403 0% 100%

ILLNESS OF NEWBORN INFANT 10 $1,431 $246 $316 100% 0% 7 $1,235 $400 $442 100% 0%

INFECTIOUS/PARASITIC 171 $184,881 $6,359 $40,360 96% 4% 52 $71,916 $2,851 $33,554 100% 0%

INTERNAL INJ/OPEN WOUND 146 $127,677 $8,620 $45,406 100% 0% 18 $9,370 $2,127 $2,359 49% 51%

MATERNITY 249 $233,080 $6,097 $96,818 99% 1% 71 $97,318 $2,413 $38,923 100% 0%

MENTAL DISORDERS 1518 $711,105 $51,943 $251,167 47% 53% 324 $139,279 $24,895 $33,802 65% 35%

MUSCULOSKELETAL SYSTEM 986 $642,933 $23,195 $217,996 97% 3% 277 $133,674 $10,480 $36,300 100% 0%

NEOPLASMS/TUMORS 318 $363,267 $9,786 $159,747 82% 18% 43 $20,419 $2,316 $4,735 100% 0%

Network Utilization by Cause Code Category



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

2015-16 2016-17

Cause Code Description Claims Claimed Deductible Paid Claims INN % OON % Claims Claimed Deductible Paid Claims INN % OON %NERVOUS SYS/SENSE ORGANS 358 $367,285 $14,277 $138,547 98% 2% 99 $50,848 $7,647 $12,764 69% 31%

POISONING/EXTERNAL CAUSES 25 $10,888 $2,373 $3,544 100% 0% 4 $2,176 $633 $362 100% 0%

RESPIRATORY SYSTEM 595 $239,088 $19,777 $72,642 97% 3% 142 $42,712 $5,386 $9,005 87% 13%

ROUTINE 1112 $320,886 $5,925 $99,619 99% 1% 293 $96,391 $1,648 $31,666 100% 0%

ROUTINE WELL BABY 8 $12,597 $200 $5,360 100% 0% 9 $15,624 $0 $10,240 100% 0%

SKIN/SUBCATANEOUS TISSUE 430 $148,827 $14,465 $30,251 97% 3% 104 $31,725 $5,361 $7,109 100% 0%

SPRAINS/STRAINS 160 $192,370 $6,389 $50,639 84% 16% 38 $12,782 $1,846 $2,847 75% 25%

SUPERFICIAL INJURY 27 $22,317 $2,218 $5,780 100% 0% 14 $8,061 $1,345 $2,366 77% 23%

SYMPTOMS/ILL-DEFINED COND 15405 $2,895,883 $178,934 $1,112,694 18% 82% 4319 $808,501 $53,183 $300,758 10% 90%

TMJ AND SKELETAL IRREGULA 1 $193 $48 $50 100% 0% 100% 0%



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

2015-16Insured

Type Diagnosis Date Diagnosis Total Charges Total Paid

Student 5/26/2015 G40301 - GEN IDIOPATHIC EPILEPSY NOT INTRACT W/STAT EPI

$186,378 $83,063

Student 3/9/2016 M87051 - IDIOPATHIC ASEPTIC NECROSIS OF RIGHT FEMUR

$171,062 $57,510

Student 10/13/2015 C8190 - HODGKIN LYMPHOMA UNSPECIFIED UNSPECIFIED SITE

$78,945 $47,952

Student 1/13/2016 M87151 - OSTEONECROSIS DUE TO DRUGS RIGHT FEMUR

$53,998 $41,153

Student 4/16/2016 S8262XA - DISPL FX LAT MALLEOLUS LT FIBULA INIT CLOS FX

$43,090 $32,038

Student 8/6/2015 1629 - MALIGNANT NEOPLASM BRONCHUS&LUNG UNSPEC SITE

$83,805 $29,493

Student 8/10/2015 81003 - CLOSED FRACTURE OF ACROMIAL END OF CLAVICLE

$40,425 $27,907

Student 9/17/2015 30000 - ANXIETY STATE, UNSPECIFIED

$54,925 $23,929

Student 10/1/2015 N390 - URINARY TRACT INFECTION SITE NOT SPECIFIED

$91,952 $22,885

Student 9/3/2015 7244 - THORACIC/LUMBOSACRAL NEURITIS/RADICULITIS UNSPEC

$46,301 $19,910

Student 7/9/2015 8442 - SPRAIN AND STRAIN OF CRUCIATE LIGAMENT OF KNEE

$60,111 $19,637

Student 5/28/2016 K810 - ACUTE CHOLECYSTITIS $31,223 $19,470

Student 10/14/2015 J0100 - ACUTE MAXILLARY SINUSITIS UNSPECIFIED

$28,940 $18,766

Student 10/17/2015 R569 - UNSPECIFIED CONVULSIONS

$31,805 $15,807

Student 11/6/2014 65663 - EXCESS FETAL GROWTH AFFECT MGMT MOTH ANTPRTM

$40,853 $15,748

Student 8/21/2015 00010 - PBM CLAIMS $20,776 $15,572

Student 11/28/2015 F3113 - BIPOLAR D/O CURRENT MANIC W/O PSYCH FEATURE SEV

$35,641 $15,339

2016-17Insured

TypeDiagnosis

Date Diagnosis Total Charges Total Paid

Student 8/22/2016 A419 - SEPSIS UNSPECIFIED ORGANISM

$44,657 $27,661

Student 10/28/2016 S02609A - FRACTURE MANDIBLE UNS INITIAL ENC CLOS FRACTURE

$62,446 $20,720

Student 8/29/2016 D649 - ANEMIA UNSPECIFIED

$28,307 $19,375

Student 12/10/2015 O09523 - SUPERVISION ELDERLY MULTIGRAVIDA THIRD TRIMESTER

$37,717 $15,486

Student 9/21/2016 N390 - URINARY TRACT INFECTION SITE NOT SPECIFIED

$14,460 $11,864

Student 9/27/2016 M25372 - OTHER INSTABILITY LEFT ANKLE

$28,042 $11,480

Student 9/14/2016 K920 - HEMATEMESIS $31,283 $10,377

Student 3/1/2016 M545 - LOW BACK PAIN $21,858 $10,201

Large Claims - $10,000 Threshold



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

2015-16Insured


Student 1/26/2015 64963 - UTERINE SIZE DATE DISCREPANCY ANTPRTM COND/COMPL

$33,846 $14,837

Student 6/23/2016 K36 - OTHER APPENDICITIS $26,581 $14,646

Student 8/6/2015 00010 - PBM CLAIMS $19,515 $13,651

Student 8/20/2015 78701 - NAUSEA WITH VOMITING

$32,563 $13,559

Student 5/12/2016 S06359A - TRAUMAT HEMORRAGE LT CEREB W/LOC UNS DUR INIT

$18,351 $13,281

Student 8/6/2015 5569 - UNSPECIFIED ULCERATIVE COLITIS

$32,063 $12,901

Student 4/19/2016 K353 - ACUTE APPENDICITIS WITH LOCALIZED PERITONITIS

$21,392 $12,375

Student 11/30/2015 F641 - DUAL ROLE TRANSVESTISM

$38,324 $12,371

Student 9/3/2014 5559 - REGIONAL ENTERITIS OF UNSPECIFIED SITE

$42,329 $11,798

Student 1/4/2016 Q379 - UNSPECIFIED CLEFT PALATE W/UNILATERAL CLEFT LIP

$20,832 $11,575

Student 9/28/2015 5409 - ACUTE APPENDICITIS WITHOUT MENTION PERITONITIS

$39,639 $11,343

Student 1/30/2016 S83241A - OTH TEAR MED MENISCUS CURR INJ RT KNEE INIT ENC

$80,610 $11,166

Student 3/3/2015 20282 - OTHER MALIG LYMPHOMAS INTRATHORACIC LYMPH NODES

$24,735 $11,066

Student 2/27/2015 8442 - SPRAIN AND STRAIN OF CRUCIATE LIGAMENT OF KNEE

$20,362 $11,052

Student 11/5/2014 30560 - NONDEP COCAINE ABUSE UNSPEC

$28,355 $10,868

Student 11/16/2015 A419 - SEPSIS UNSPECIFIED ORGANISM

$70,877 $10,653

Student 1/9/2016 N8320 - UNSPECIFIED OVARIAN CYSTS

$21,975 $10,622

Student 10/29/2015 K352 - ACUTE APPENDICITIS WITH GENERALIZED PERITONITIS

$28,078 $10,577

Student 9/26/2015 81600 - CLOSED FRACTURE UNSPEC PHALANX/PHALANGES HAND

$89,424 $10,487

Student 8/31/2015 9593 - INJURY OTHER&UNSPECIFIED ELBOW FOREARM&WRIST

$16,675 $10,174



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

2015-16Insured


Student 5/13/2016 S199XXA - UNSPECIFIED INJURY OF NECK INITIAL ENCOUNTER

$17,476 $10,005



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Paid Claims INN OON Claim

Count INN OON100.0% 0.0% 100.0% 0.0%

Admissions $38,223 1781.9% 18.1% 85.7% 14.3%

Physician Visits $64,880 90094.5% 5.5% 93.1% 6.9%

All $401,688 2549

Cause Code Prior 2 Yrs. 2015-16 2016-17Category Paid Claims INN OON Paid Claims INN OON Paid Claims INN OON

48.0% 52.0% 46.8% 53.2% 59.4% 40.6%Behavioral Health $276,354 $250,946 $25,408

56.4% 43.6% 57.0% 43.0% 53.9% 46.1%Medical $3,586,417 $2,943,627 $642,790

Provider Network Experience

School Year Paid Claims INN Medical INN Rx SHC OON

64.3% 23.3% 1.5% 9.9%

2014-15 $3,039,630

54.9% 28.2% 5.6% 9.3%

2015-16 $3,195,851

52.1% 36.8% 7.3% 3.0%

2016-17 $729,013



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Top 20 Rendering Providers2016-17 School Year

Provider Name Paid Claims INN OON ClaimantCount INN OON

MEDSTAR - GEORGETOWN MEDICAL CENTER $10,725 100.0% 0.0% 4 100.0% 0.0%

MEDSTAR - GEORGETOWN MEDICAL CENTER $6,432 100.0% 0.0% 2 100.0% 0.0%

LABORATORY CORPORATION OF AMERICA H $5,772 100.0% 0.0% 81 100.0% 0.0%

LUCY WEBB HAYES NATIONAL TRAINING S $4,808 100.0% 0.0% 3 100.0% 0.0%

CAPITAL WOMEN'S CARE LLC $2,914 100.0% 0.0% 6 100.0% 0.0%

MEMORIAL HERMANN SURGERY CENTER KIN $1,643 100.0% 0.0% 1 100.0% 0.0%

JOSEPH BOONSIRI $887 0.0% 100.0% 1 0.0% 100.0%

MEDSTAR MEDICAL GROUP II LLC $886 100.0% 0.0% 1 100.0% 0.0%

CHILDREN'S HOSPITAL $775 100.0% 0.0% 2 100.0% 0.0%

LUCY WEBB HAYES NATIONAL TRAINING S $733 100.0% 0.0% 1 100.0% 0.0%


OJAS SHAH $641 100.0% 0.0% 1 100.0% 0.0%

ANUP VORA $616 100.0% 0.0% 1 100.0% 0.0%

LABCORP BURLINGTON $556 100.0% 0.0% 10 100.0% 0.0%

MICHAEL J MUNDENAR DMDPC $547 100.0% 0.0% 1 100.0% 0.0%

DAVID PARK $546 0.0% 100.0% 1 0.0% 100.0%


WASHINGTON RADIOLOGY ASSOCIATES PC $532 100.0% 0.0% 2 100.0% 0.0%

MICHAEL TRAISTER $521 100.0% 0.0% 1 100.0% 0.0%

SUMMIT AMBULATORY SURGICAL CENTER L $506 100.0% 0.0% 1 100.0% 0.0%



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Top 10 Rx CategoriesTop 10 Therapeutic Classes by Claimant Count

Therapeutic ClassClaimant

Count Co PayPaid

Claims

SYSTEMIC CONTRACEPTIVES 383 $2,195 $47,929

PSYCHOSTIMULANTS-ANTIDEPRESSANTS 162 $7,216 $15,683

PENICILLINS 130 $1,420 $218

GLUCOCORTICOIDS 110 $1,747 $5,107

AMPHETAMINE PREPARATIONS 85 $4,873 $36,780

BRONCHIAL DILATORS 80 $2,625 $8,292

ANTIFUNGALS 73 $1,045 $1,238

ANTICONVULSANTS 71 $2,639 $7,727

ERYTHROMYCINS 70 $730 $853

OTHER ANTIBIOTICS 69 $865 $2,027

Top 10 Rx Drugs by Paid Claims

Drug Name TierClaimant

Count Co PayPaid

Claims

TRUVADA 2 11 $1,155 $46,972

HUMIRA PEN 2 1 $175 $20,196

VYVANSE 2 32 $2,783 $17,049

ADDERALL XR 1 28 $770 $15,754

CONCERTA 1 12 $520 $15,677

ATRIPLA 2 2 $210 $14,173

TRIUMEQ 2 1 $175 $11,960

ARIPIPRAZOLE 1 11 $330 $11,463

LIALDA 2 5 $560 $11,229

NUVARING 2 20 $0 $9,872

Top 10 Rx Drugs Prescribed

Drug Name TierScript Count

Claimant Count Co Pay

Paid Claims

AMPHETAMINE/DEXTROAMPHETAMINE 1 128 50 $1,260 $3,284

JUNEL FE 1/20 1 127 56 $0 $2,526

SERTRALINE HCL 1 127 38 $1,122 $98

ESCITALOPRAM OXALATE 1 121 36 $1,045 $320

VYVANSE 2 83 32 $2,783 $17,049

AMOXICILLIN/CLAVULANATE POTASSIUM 1 75 69 $690 $153

AZITHROMYCIN 1 70 67 $680 $138

FLUCONAZOLE 1 69 51 $675 $390

VENTOLIN HFA 1 65 51 $525 $2,191

PENICILLIN V POTASSIUM 1 39 36 $370 $38



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

tPending Visualization

Prescription Drug Utilization by Tier

2015-16 2016-17Claimant

Count Copay Paid Claims Claimant Count Copay Paid Claims

Tier 1 1,342 $82,786 $372,498 918 $31,397 $132,937

Tier 2 150 $19,314 $263,498 99 $7,268 $147,592

Tier 3 235 $27,307 $248,280 113 $8,975 $51,338



2018-19 Clie

nt Rep

orting In

-Dev

elopmen

t

Pending visualizations

University of KansasWaiver Audit Statistics as of August 27, 2017

Number of Submitted Waivers 296

Number of Approved Waivers 252Number of Denied Waivers 40Pending Waivers 2Voided Waivers 2

Summary

Total Number

of Denials Description

13 Could not verify with carrier due to missing info13 Not Active5 Could not verify with carrier, carrier would not verify3 Pre-existing Condition limitation2 No maternity coverage1 No Prescription Drug Plan 1 No IP and/or OP Mental Nervous1 No preventive care1 Annual Deductible >$500

40

Page 1 of 4

University of Kansas - Medical CenterWaiver Audit Statistics as of August 27, 2017



Summary

Total Number


2 Could not verify with carrier due to missing info1 Insufficient Medical Evacuation/Repatriation (MER) benefits1 No Prescription Drug Plan 1 No IP and/or OP Mental Nervous1 Pre-existing Condition limitation6

Page 2 of 4

Kansas State UniversityWaiver Audit Statistics as of August 27, 2017



Summary

Total Number


21 Could not verify with carrier due to missing info15 Not Active5 Insufficient Medical Evacuation/Repatriation (MER) benefits5 No Prescription Drug Plan 4 No maternity coverage4 No preventive care4 Annual Deductible >$5003 No IP and/or OP Mental Nervous3 Pre-existing Condition limitation3 Auditor could not complete audit*3 Plan does not have Unlimited Benefits1 Could not verify with carrier, carrier would not verify

71

Page 3 of 4

Emporia State UniversityWaiver Audit Statistics as of August 27, 2017



Summary

Total Number


8 Annual Deductible >$5003 Could not verify with carrier due to missing info3 Not Active3 No Prescription Drug Plan 2 Auditor could not complete audit*2 No preventive care2 Plan does not have Unlimited Benefits1 No maternity coverage

24

Page 4 of 4

1

38670 Highway 285, PO Box 212, Jefferson, CO 80456 toll-free phone 866-780-3824 Date: August 28, 2017 Name of Project: Student Health Insurance Waiver and Eligibility Services ECI Services

Request for Information (RFI) August 24, 2017 Client: Kansas Board of Regents *********************************************************************************************

This document is in response to a Request for Information (RFI) by United HealthCare StudentResources on behalf of the Kansas Board of Regents with the following requested information:

1. Which universities opted to have ECI process their waivers? The following state universities opted for either waiver services or eligibility & waiver services for their international students as follows:

University of Kansas (KU) Waiver Only University of Kansas Medical Campus (KU-MC) Waiver Only Kansas State University (KSU) Waiver and Eligibility Emporia State University (ESU) Waiver and Eligibility

The following campus stated they would consider implementing a waiver and/or eligibility process for Spring 2018 or Fall 2018 as follows:

Pittsburg State University (PSU) The following campus has not stated their intent to implement waiver and/or eligibility services as follows:

Wichita State University

2. Data on how many waivers processed for each school

Please note that the following number of waiver audits and positive enrollments (if applicable) were submitted by school as of 08/28/2017: University # Submitted Waivers # Positive Enrollments University of Kansas (KU) 296 N/A University of Kansas Medical Campus (KU-MC) 28 N/A Kansas State University (KSU) 194 29 Emporia State University (ESU) 98 ___________ 50_ TOTAL 616 79

2

3. How many waivers denied and reasons for denials See the attachment for Approval/Disapproval Reports by University. Since the Waiver process has not been completed for Fall 2017 finalized reports will be run in September 2017 with more complete results.

4. How many follow-ups were made with the students (verification questions, more information, etc.)

Since the schools and ECI Services are not finished with the entire and enrollment waiver audit process we will provide this information upon completion of the waiver process for Fall 2017 along with more detailed reports on enrollment (positive enrollment whereas the student wanted to enroll in SHIP so they could access benefits sooner) and finalized comparative approval/denial reports.

5. Any other general information that you think would be informative/helpful

ECI Services plans to meet with each University in October 2017 and go over the results of the waiver and eligibility processes for each school and discuss the entire process, especially as it pertains to the exception processes for each University, as technically the exception process is complicated at some schools. ECI plans to review what transpired at each school and establish what we can do for an even more successful process in future semesters and to establish a formal appeal process. Also, we will evaluate if the schools want to re-audit approved waivers for eligibility only status for Spring 2018 and full audit for new international students.

On a general note, we feel that each school has given ECI very positive feedback that by ECI performing the waiver audit and positive enrollment process this has alleviated a substantial work load for the University employees involved in these tasks. Our contacts seem to appreciate the ability to review results on a student detail level to help make decisions and the ability to easily pull reports. Also, by undergoing the process it was felt that students were being properly evaluated for approval or denial decisions on waiver plans submitted for evaluation. Given the short implementation schedule everyone seems to be generally very pleased with how the process has gone this first semester even though we are not finished with Fall 2017.

If you have any additional questions or concerns, please feel free to contact me at 720-214-0335 or [email protected] Sincerely, Laura L.M. Evans President, ECI Services

mailto:[email protected]

Documents

STUDENT HEALTH INSURANCE ADVISORY COMMITTEE … · UHCSR.com Web-X presentation . Terri Bradford with UHCSR provided a webinar presentation of the upgraded website. ... HealthiestYou