Claim Analytics and Decision Support Tools

Your NIS Consultant will identify cost and utilization disparities using our claim analytics and decision support tools…With these sophisticated tools, you can “test drive” potential changes, so you can see the impact of a change—before making any decisions.

Management Report

This easy-to-read report benchmarks your data against national norms from Thomson Reuters MarketScan® Research Databases and Kaiser Family Foundation. It further breaks down comparisons by geographic region, industry and company size, and includes dynamic charts and detailed explanations. Explore data comparisons for over 70 different medical categories, including:

  • Total Health Plan Costs
  • Inpatient and Outpatient Claims
  • Emergency Room and Office Visit Utilization and Cost
  • Claims by Major Diagnostic Categories
  • Wellness
  • And many more!

Prescription Management Report

We can also offer a prescription drug claims analysis report. The Prescription Management Report benchmarks Rx claims data to help us assess whether your costs are appropriate and where problem areas may exist. Among the categories analyzed are:

  • Paid Summary
  • Total Member Cost Share
  • Mail Service Utilization
  • Brand Name vs. Generic Utilization
  • And more!

Multiproject Reporting

The Multiproject Reporting function allows us to compare up to four different data sets. This allows us to track data trends and patterns from year to year or compare between multiple locations or divisions for a single year.

  • Includes the same categories as the standard management report
  • Useful for strategic long-term planning and evaluation
  • Helps isolate disparities to address among divisions or branches


The sophisticated Drill-Down feature allows us to get to the source of the problem by breaking data down into targeted, specific segments to analyze. By pinpointing the who, what, where and why of a problem area, together we can implement strategic, effective solutions such as awareness campaigns, disease management programs, plan design changes, wellness initiatives and more.

Find health plan answers such as:

  • Who is going to the doctor? Are they using in-network or out-of-network? Why are they going?
  • Who is using the emergency room most – employees, spouses or dependents? Why is utilization so high?
  • Which segments of the employee/dependent population are utilizing preventive services most?

Investigate prescription drug claim questions such as:

  • Who is utilizing mail-order vs. traditional pharmacy? What is the cost differential?
  • How often are generics being utilized when available? Who is choosing generic over brand name?
  • Are pricey specialty drugs responsible for a disproportionately high portion of your plan cost? Which demographics have the highest specialty drug utilization rate?

Alternative Modeling

After analyzing your data and identifying problem areas, the next step is developing strategic solutions to address those issues. The Alternative Modeling feature can help us “try out” different plan design alternatives and see how changes will impact both your budget and employees.

  • Compare the current plan against alternative options, including Health Savings Accounts (HSAs) or Health Reimbursement Accounts (HRAs).
  • Apply the information we’ve gathered. Was emergency room usage disproportionately high? Examine the impact of raising ER copays to discourage unnecessary visits.
  • Identify cost-cutting opportunities by changing factors such as copays, deductibles, out-of-pocket maximums and more.
  • Learn how many claimants are affected by each change, to achieve cost-savings while retaining value for plan members.

Disease Profiler

Using reliable data from Thomson Reuters MarketScan® Research Databases, the Disease Profiler can show average costs of claims by disease category. We use this valuable resource to help you:

  • Predict costs and budget for future health and Rx claims costs
  • Negotiate more accurate rates with stop-loss carriers
  • Design and implement a disease management program to address the needs of your employee population
  • Evaluate and manage risk within the plan

Contact NIS today for a FREE 15-minute consultation