Claims Analysis

Appropriate Health Plan Utilization
NIS will thoroughly analyze your health plan claims through our impartial third-party claim analytics tools to find areas where we can encourage appropriate utilization.

Sample Claims Analysis

Step 1

Benchmark

Identify problem areas. Example: Emergency room utilization is high.

Step 2

Dig Deeper

Example: Analysis shows that a common reason for ER visits is ear/nose/throat issues.

Step 3

Explore Solutions

Example: Possible solutions – Increase the Emergency Room copay (model cost impact), initiate an education campaign, and/or create awareness of nearby urgent care centers.

Step 4

Implement Solutions

You can decide based on our analysis and modeling whether you want to implement one or more of the solutions. We will help you implement!