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.
Identify problem areas. Example: Emergency room utilization is high.
Example: Analysis shows that a common reason for ER visits is ear/nose/throat issues.
Example: Possible solutions – Increase the Emergency Room copay (model cost impact), initiate an education campaign, and/or create awareness of nearby urgent care centers.
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!