Att E - Claims and Enrollment Reporting Anthem.pdf
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- Attached to
- RFP #2021-04 Dental Services
- Solicitation number
- 2021 - 04
- Issued by
- Wisconsin
About this file
This is a Claims and Enrollment Reporting document for dental membership coverage provided by Anthem for Dunn County Employees, covering the period from January 2016 through April 2017. The document tracks enrollment across four dental contract types: Subscriber only, Subscriber & Spouse/Dependent, Subscriber & Child/Children, and Family plans. During the reporting period, Subscriber-only enrollment ranged from 7 to 11 members, Subscriber & Spouse/Dependent plans ranged from 20 to 22 members, Subscriber & Child/Children plans ranged from 9 to 14 members, and Family plans ranged from 24 to 27 members. The document also presents aggregate member months data showing total enrollment counts across all contract types, with Family plans consistently representing the largest enrollment category at over 100 member months during the period.
The document provides historical enrollment and claims data that serves as baseline information for the dental services procurement process. This reporting data is relevant to RFP #2021-04 for Dental Services, through which Dunn County solicited proposals from qualified service providers for the delivery of dental insurance coverage to county employees and their families. The enrollment trends and membership patterns documented in this report would inform prospective bidders regarding the current and historical utilization of dental benefits and assist in developing accurate pricing proposals based on the expected member populations and coverage types required under a new dental services contract.
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Dental Membership
DUNN COUNTY EMPLOYEES - Total Account Current Period: Jan 2016 - Dec 2020
Prior Period: Jan 2016 - Dec 2020
Dental
Contract Type Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 Jul 2016 Aug 2016 Sep 2016 Oct 2016 Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017 Apr 2017
Subscriber 9 8 8 7 7 7 7 7 9 9 8 11 9 10 11 11
Subscriber & Spouse/Dependent 21 22 22 21 21 20 20 21 21 21 21 21 20 20 20 20
Subscriber & Child/Children 11 11 11 12 12 12 13 13 14 14 14 12 10 10 10 9
Family 24 25 25 25 25 25 25 25 25 25 25 25 25 25 26 27
Dental
Contract Type Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 Jun 2016 Jul 2016 Aug 2016 Sep 2016 Oct 2016 Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017 Apr 2017
Subscriber 9 8 8 7 7 7 7 7 9 9 8 11 9 10 11 11
Subscriber & Spouse/Dependent 42 44 44 42 42 40 40 42 42 42 42 42 40 40 40 40
Subscriber & Child/Children 26 26 26 27 27 27 29 29 32 32 32 27 23 23 23 21
Family 100 103 103 104 104 104 104 104 104 103 102 102 102 102 105 108
Contracts by Month
Current Member Months
Current Prior
Age Range Male Female Total Male Female Total
<1 0 1 1 0 1 1
01-04 5 5 10 5 5 10
05-14 18 10 28 18 10 28
15-24 18 15 33 18 15 33
25-34 20 17 37 20 17 37
35-44 15 15 30 15 15 30
45-54 13 15 28 13 15 28
55-64 11 15 26 11 15 26
65+ 2 1 3 2 1 3
Total Members 102 94 196 102 94 196
Members Avg Age 31.0 34.0 32.5 31.0 34.0 32.5
Average Age - Benchmark 36.3 37.2 36.7 36.3 37.2 36.7
Dental Membership by Age/Gender
Total Contracts 65 66 66 65 65 64 65 66 69 69 68 69 64 65 67 67
Benchmark Avg Members per Contract 2.1 2.1 2.1 2.1 2.1 2.1 2.1 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0
Benchmark based on total Dental large group block of business
Total Members 177 181 181 180 180 178 180 182 187 186 184 182 174 175 179 180
Average Members per Contract 2.7 2.7 2.7 2.8 2.8 2.8 2.8 2.8 2.7 2.7 2.7 2.6 2.7 2.7 2.7 2.7
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
Report Run Date: 02/09/2021 Page 1 of 4 Total Report Package Page 1 of 12
Dental
May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2017 Jan 2018 Feb 2018 Mar 2018 Apr 2018 May 2018 Jun 2018 Jul 2018 Aug 2018 Sep 2018 Oct 2018 Nov 2018
10 11 11 12 12 13 12 12 14 14 15 15 15 14 13 12 12 12 12
19 19 19 18 19 16 15 16 14 14 14 15 15 15 15 15 15 15 16
8 8 8 8 8 8 9 9 9 9 8 8 9 9 7 7 7 7 7
29 29 29 29 28 27 28 27 28 28 28 29 30 30 30 30 29 29 29
Dental
May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2017 Jan 2018 Feb 2018 Mar 2018 Apr 2018 May 2018 Jun 2018 Jul 2018 Aug 2018 Sep 2018 Oct 2018 Nov 2018
10 11 11 12 12 13 12 12 14 14 15 15 15 14 13 12 12 12 12
38 38 38 36 38 32 30 32 28 28 28 30 30 30 30 30 30 30 32
19 19 19 19 19 19 22 22 22 22 20 20 22 22 17 17 17 17 17
116 116 117 116 113 109 114 110 109 109 109 112 116 116 116 116 113 113 114
66 67 67 67 67 64 64 64 65 65 65 67 69 68 65 64 63 63 64
2.0 2.0 1.9 1.9 1.9 1.9 1.9 1.9 1.9 1.9 1.9 2.0 2.0 2.0 1.9 1.9 1.9 1.9 1.9
183 184 185 183 182 173 178 176 173 173 172 177 183 182 176 175 172 172 175
2.8 2.7 2.8 2.7 2.7 2.7 2.8 2.8 2.7 2.7 2.6 2.6 2.7 2.7 2.7 2.7 2.7 2.7 2.7
Report Run Date: 02/09/2021 Page 2 of 4 Total Report Package Page 2 of 12
Dec 2018 Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 Jun 2019 Jul 2019 Aug 2019 Sep 2019 Oct 2019 Nov 2019 Dec 2019 Jan 2020 Feb 2020 Mar 2020 Apr 2020 May 2020 Jun 2020
13 13 14 13 13 14 15 14 13 14 14 15 15 15 15 15 15 16 17
16 17 16 16 16 16 16 16 17 18 18 18 19 20 20 21 21 21 19
6 8 8 8 8 8 8 8 8 8 7 7 7 10 10 10 10 10 10
31 30 31 30 30 30 30 30 29 28 29 29 28 29 28 28 29 29 28
Dental
Dec 2018 Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 Jun 2019 Jul 2019 Aug 2019 Sep 2019 Oct 2019 Nov 2019 Dec 2019 Jan 2020 Feb 2020 Mar 2020 Apr 2020 May 2020 Jun 2020
13 13 14 13 13 14 15 14 13 14 14 15 15 15 15 15 15 16 17
32 34 32 32 32 32 32 32 34 36 36 36 38 40 40 42 42 42 38
15 19 19 19 19 19 19 19 19 19 17 17 17 25 25 25 25 25 25
122 120 122 118 118 117 117 117 112 108 111 111 108 113 110 110 114 114 111
66 68 69 67 67 68 69 68 67 68 68 69 69 74 73 74 75 76 74
1.9 1.9 1.9 1.9 1.9 1.9 1.9 1.9 1.9 1.8 1.8 1.8 1.8 1.9 1.9 1.9 1.9 1.9 1.9
182 186 187 182 182 182 183 182 178 177 178 179 178 193 190 192 196 197 191
2.8 2.7 2.7 2.7 2.7 2.7 2.7 2.7 2.7 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6 2.6
Report Run Date: 02/09/2021 Page 3 of 4 Total Report Package Page 3 of 12
Jul 2020 Aug 2020 Sep 2020 Oct 2020 Nov 2020 Dec 2020 Average Current
Average Prior Trend
18 19 18 18 18 18 13 13 0.0%
19 18 18 18 18 17 18 18 0.0%
10 10 10 11 11 11 9 9 0.0%
29 29 29 29 29 29 28 28 0.0%
Dental
Jul 2020 Aug 2020 Sep 2020 Oct 2020 Nov 2020 Dec 2020 Average Current
Average Prior
Trend Member Months
18 19 18 18 18 18 13 13 0.0% 761
38 36 36 36 36 34 36 36 0.0% 2,170
25 25 25 28 28 28 22 22 0.0% 1,347
116 116 116 116 116 116 111 111 0.0% 6,677
76 76 75 76 76 75 68 68 0.0%
1.9 1.8 1.8 1.8 1.8 1.8 1.9 1.9 0.0%
197 196 195 198 198 196 183 183 0.0% 10,955
2.6 2.6 2.6 2.6 2.6 2.6 2.7 2.7 0.0%
Report Run Date: 02/09/2021 Page 4 of 4 Total Report Package Page 4 of 12
Prior Period: Jan 2016 - Dec 2020
Current Period: Jan 2016 - Dec 2020
Audit Parameters Trail
Parameter Name Parameter Value Anthem Account Control ID W0022037 Anthem Account Control Name DUNN COUNTY EMPLOYEES Master Segmentation ID W0022037-00001 Master Segmentation Name Total Account Group ID(s) 00128279 ;W81280 Subgroup ID(s) Plan Code(s) Plan Type Code(s) Benefit Package ID(s) Claim Code ID(s) Group Status NA Rating Relation Code Department Number Clock Number Association Client ID NA Claim Reporting Code ID 1 Claim Reporting Code ID 2 Claim Reporting Code ID 3 Employer Group Reporting Code ID 1 Employer Group Reporting Code ID 2 Employer Group Reporting Code ID 3 Fully Insured Indicator Member Network ID Package Number Medicare Indicator (Medicare Primary) Par Plan ID/Participating Plan Code Plan Group Code CDHP Category Code Primary Coverage Indicator (Anthem Primary) Time Period Custom
Report Run Date: 02/09/2021
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
#RECURSIVE
Total Report Package Page 5 of 12
Dental Enrollment and Claims
Current Period: Jan 2016 - Dec 2020
Month Subscriber Subscriber & Spouse/Dependent
Subscriber & Child/ Children Family Total Subscriber Total Members Number Of Claims Paid Claims Percent of Total
Paid Claims
Jan 2016 9 21 11 24 65 177 22 $3,662 1.3%
Feb 2016 8 22 11 25 66 181 29 $7,064 2.5%
Mar 2016 8 22 11 25 66 181 25 $3,284 1.2%
Apr 2016 7 21 12 25 65 180 12 $2,246 0.8%
May 2016 7 21 12 25 65 180 25 $5,033 1.8%
Jun 2016 7 20 12 25 64 178 29 $5,594 2.0%
Jul 2016 7 20 13 25 65 180 22 $3,343 1.2%
Aug 2016 7 21 13 25 66 182 32 $6,671 2.4%
Sep 2016 9 21 14 25 69 187 28 $5,175 1.8%
Oct 2016 9 21 14 25 69 186 29 $6,192 2.2%
Nov 2016 8 21 14 25 68 184 16 $3,293 1.2%
Dec 2016 11 21 12 25 69 182 28 $5,632 2.0%
Jan 2017 9 20 10 25 64 174 32 $7,532 2.7%
Feb 2017 10 20 10 25 65 175 22 $4,597 1.6%
Mar 2017 11 20 10 26 67 179 33 $7,372 2.6%
Apr 2017 11 20 9 27 67 180 22 $3,793 1.4%
May 2017 10 19 8 29 66 183 15 $2,395 0.9%
Jun 2017 11 19 8 29 67 184 30 $7,147 2.6%
Jul 2017 11 19 8 29 67 185 31 $4,430 1.6%
Aug 2017 12 18 8 29 67 183 29 $6,151 2.2%
Sep 2017 12 19 8 28 67 182 34 $7,515 2.7%
Oct 2017 13 16 8 27 64 173 25 $4,066 1.5%
Nov 2017 12 15 9 28 64 178 23 $4,419 1.6%
Dec 2017 12 16 9 27 64 176 10 $1,920 0.7%
Jan 2018 14 14 9 28 65 173 25 $4,590 1.6%
Feb 2018 14 14 9 28 65 173 17 $3,528 1.3%
Mar 2018 15 14 8 28 65 172 26 $3,831 1.4%
Apr 2018 15 15 8 29 67 177 15 $3,606 1.3%
May 2018 15 15 9 30 69 183 20 $2,985 1.1%
Jun 2018 14 15 9 30 68 182 32 $5,802 2.1%
Jul 2018 13 15 7 30 65 176 26 $4,102 1.5%
Aug 2018 12 15 7 30 64 175 26 $5,579 2.0%
Sep 2018 12 15 7 29 63 172 29 $4,795 1.7%
Oct 2018 12 15 7 29 63 172 21 $3,014 1.1%
Nov 2018 12 16 7 29 64 175 17 $2,660 1.0%
Dec 2018 13 16 6 31 66 182 25 $5,576 2.0%
Jan 2019 13 17 8 30 68 186 28 $5,269 1.9%
Feb 2019 14 16 8 31 69 187 30 $5,213 1.9%
Report Run Date: 02/09/2021 Page 1 of 2Total Report Package Page 6 of 12
Dental Enrollment and Claims
Current Period: Jan 2016 - Dec 2020
Mar 2019 13 16 8 30 67 182 27 $5,143 1.8%
Apr 2019 13 16 8 30 67 182 18 $3,164 1.1%
May 2019 14 16 8 30 68 182 21 $3,125 1.1%
Jun 2019 15 16 8 30 69 183 18 $3,244 1.2%
Jul 2019 14 16 8 30 68 182 36 $8,243 2.9%
Aug 2019 13 17 8 29 67 178 35 $5,756 2.1%
Sep 2019 14 18 8 28 68 177 23 $4,559 1.6%
Oct 2019 14 18 7 29 68 178 21 $4,435 1.6%
Nov 2019 15 18 7 29 69 179 13 $2,522 0.9%
Dec 2019 15 19 7 28 69 178 25 $5,110 1.8%
Jan 2020 15 20 10 29 74 193 22 $5,131 1.8%
Feb 2020 15 20 10 28 73 190 14 $3,845 1.4%
Mar 2020 15 21 10 28 74 192 36 $6,438 2.3%
Apr 2020 15 21 10 29 75 196 11 $2,018 0.7%
May 2020 16 21 10 29 76 197 17 $3,640 1.3%
Jun 2020 17 19 10 28 74 191 24 $4,603 1.6%
Jul 2020 18 19 10 29 76 197 29 $6,016 2.1%
Aug 2020 19 18 10 29 76 196 24 $4,986 1.8%
Sep 2020 18 18 10 29 75 195 22 $3,873 1.4%
Oct 2020 18 18 11 29 76 198 32 $5,786 2.1%
Nov 2020 18 18 11 29 76 198 22 $3,531 1.3%
Dec 2020 18 17 11 29 75 196 22 $5,675 2.0%
Total 1,452 $279,917 100.0%
Average 13 18 9 28 68 183 24 $4,665
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
Report Run Date: 02/09/2021 Page 2 of 2Total Report Package Page 7 of 12
Current Period: Jan 2016 - Dec 2020
Audit Parameters Trail
Parameter Name Parameter Value Anthem Account Control ID W0022037 Anthem Account Control Name DUNN COUNTY EMPLOYEES Master Segmentation ID W0022037-00001 Master Segmentation Name Total Account Group ID(s) 00128279 ;W81280 Subgroup ID(s) Plan Code(s) Plan Type Code(s) Benefit Package ID(s) Claim Code ID(s) Group Status NA Rating Relation Code Department Number Clock Number Association Client ID Claim Reporting Code ID 1 Claim Reporting Code ID 2 Claim Reporting Code ID 3 Employer Group Reporting Code ID 1 Employer Group Reporting Code ID 2 Employer Group Reporting Code ID 3 Fully Insured Indicator Member Network ID Package Number Medicare Indicator (Medicare Primary) Par Plan ID/Participating Plan Code Plan Group Code CDHP Category Code Primary Coverage Indicator (Anthem Primary) Time Period Custom Paid Amount Type Standard Reporting Paid Amount + HRA
Report Run Date: 02/09/2021
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
Total Report Package Page 8 of 12
Dental Claims Summary by Service Category
Current Period: Jan 2016 - Dec 2020
Prior Period: Jan 2016 - Dec 2020
Preventive and Diagnostic
Subtotal 258 3,037 76.4% $25,226 $152,319 $13.90 $9.05 $13.90 $9.05
Benchmark based on total Dental large group block of business
Grand Total 262 3,976 100.0% $114,073 $279,917 $25.55 $20.26 $25.55 $20.26
General Adjunctive
Subtotal 39 72 1.8% $5,803 $1,112 $0.10 $0.12 $0.10 $0.12
Restoration
Minor 140 595 15.0% $59,400 $89,766 $8.19 $5.30 $8.19 $5.30
Endodontic 13 20 0.5% $3,352 $6,263 $0.57 $1.11 $0.57 $1.11
Periodontic 32 132 3.3% $4,822 $15,943 $1.46 $1.09 $1.46 $1.09
Oral Surgery 36 91 2.3% $4,999 $11,506 $1.05 $1.28 $1.05 $1.28
Major 2 2 0.1% $3,280 $0 $0.00 $0.39 $0.00 $0.39
Prosthodontic 4 6 0.2% $3,314 $460 $0.04 $0.55 $0.04 $0.55
Subtotal 166 846 21.3% $79,168 $123,938 $11.31 $9.72 $11.31 $9.72
PMPM PMPM
Service Category Unique Claimants
Number of Procedures
Percent of Procedures
Member Out of Pocket Paid Amount Current Benchmark Prior Benchmark
Orthodontia
Subtotal 4 21 0.5% $3,877 $2,547 $0.23 $0.21 $0.23 $0.21
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
Report Run Date: 02/09/2021 Page 1 of 1Total Report Package Page 9 of 12
Prior Period: Jan 2016 - Dec 2020
Current Period: Jan 2016 - Dec 2020
Audit Parameters Trail
Parameter Name Parameter Value Anthem Account Control ID W0022037 Anthem Account Control Name DUNN COUNTY EMPLOYEES Master Segmentation ID W0022037-00001 Master Segmentation Name Total Account Group ID(s) 00128279 ;W81280 Subgroup ID(s) Plan Code(s) Plan Type Code(s) Benefit Package ID(s) Claim Code ID(s) Group Status NA Rating Relation Code Department Number Clock Number Association Client ID Claim Reporting Code ID 1 Claim Reporting Code ID 2 Claim Reporting Code ID 3 Employer Group Reporting Code ID 1 Employer Group Reporting Code ID 2 Employer Group Reporting Code ID 3 Fully Insured Indicator Member Network ID Package Number Medicare Indicator (Medicare Primary) Par Plan ID/Participating Plan Code Plan Group Code CDHP Category Code Primary Coverage Indicator (Anthem Primary) Time Period Custom Paid Amount Type Standard Reporting Paid Amount + HRA
Report Run Date: 02/09/2021
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
Total Report Package Page 10 of 12
Network Status Unique Claimants
Number of Claims
Charge Submitted
Non Covered Amount
Covered Expense Amount
Network Savings
Percent Network Savings
Allowed Amount Deductible Coinsurance/
Copayment
In-Network 134 254 $69,634 $4,064 $65,571 $9,967 15.2% $55,603 $0 $3,170
Out-of-Network 241 1,172 $347,271 $80,370 $266,902 $2,227 0.8% $264,675 $0 $26,470
Total Dental 262 1,426 $416,906 $84,433 $332,472 $12,194 3.7% $320,278 $0 $29,640
Coordination of Benefits
Savings
$1,621
$8,810
$10,432
Dental Network Utilization and Plan Savings
DUNN COUNTY EMPLOYEES - Total Account Current Period: Jan 2016 - Dec 2020
Other Reduction Amount
$434
-$145
$289
Paid Amount Percent Paid Amount
$50,378 18.0%
$229,539 82.0%
$279,917
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
Report Run Date: 02/09/2021 Page 1 of 1Total Report Package Page 11 of 12
Current Period: Jan 2016 - Dec 2020
Audit Parameters Trail
Parameter Name Parameter Value Anthem Account Control ID W0022037 Anthem Account Control Name DUNN COUNTY EMPLOYEES Master Segmentation ID W0022037-00001 Master Segmentation Name Total Account Group ID(s) 00128279 ;W81280 Subgroup ID(s) Plan Code(s) Plan Type Code(s) Benefit Package ID(s) Claim Code ID(s) Group Status NA Rating Relation Code Department Number Clock Number Association Client ID Claim Reporting Code ID 1 Claim Reporting Code ID 2 Claim Reporting Code ID 3 Employer Group Reporting Code ID 1 Employer Group Reporting Code ID 2 Employer Group Reporting Code ID 3 Fully Insured Indicator Member Network ID Package Number Medicare Indicator (Medicare Primary) Par Plan ID/Participating Plan Code Plan Group Code CDHP Category Code Primary Coverage Indicator (Anthem Primary) Time Period Custom Paid Amount Type Standard Reporting Paid Amount + HRA
Report Run Date: 02/09/2021
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation ("Compcare") or Wisconsin Collaborative Insurance Company ("WCIC"); Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Copyright (c) 2012, Anthem Blue Cross and Blue Shield. All Rights Reserved. This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.
Total Report Package Page 12 of 12
| Dental Membership |
| Audit Parameters Trail |
| Dental Enrollment and Claims |
| Audit Parameters Trail |
| Dental Claims Summary by Service Category |
| Audit Parameters Trail |
| Dental Network Utilization and Plan Savings |
| Audit Parameters Trail |
File details come from the government source that posted it. Updated .