ATT101_TPA_SummaryVolumeData_Shell.xlsx

Overview

The summary volume data contains tables and visualizations using data from all operational areas of the WTC Health Program pertaining to the level and complexity of effort required by the incoming TPA. Supplementary tabs are also included here to provide additional context that may be relevant to membership composition and trends that may be informative for the development of new recommendations and strategies.

Primary Contents:

- Current Data Exchanges: 1) Definitions, 2) Summary File Information, 3) Frequency, destination and type of current data exchanges, 4) Current Data Exchanges by Topic and Frequency

- Enrollment Applications and Processing: 1) Application Volume by Week, Member Type, and Status over the Past Year, 2) Application Volume by Month, Application Type, Average Processing Time, 3) # New Applications over the Last 3 Years by Month, Type, Language, 4) Enrollments Decisions Completed per Month, 5) # New Enrollees by Location over the Last 3 Years by Month and Member Type, 6) # New Enrollees over the Last 3 Years by Month, Member Type, Current Age

- CCE Assignment & Transfer: 1) CCE Assignment and Frequency of Member Transfers, 2) Transfer Requests per Month and Related Processing Time, 3) # Transfers over the Last 3 Years by Month and Member Type

- Designated Representative Processing: 1) DR Request and Revocation Volume

- Certification Trends and Processing: 1) Certification Requests Received by Week and Member Type over the Last Year, 2) # Processable vs Unprocessable Certification Requests Received in Last 3 Years, 3) # New Certifications by CCE/NPN per Month over the Last 3 Years, 4) New Certifications over Time by Zadroga Category and Care Suite

- Member Demographics & Management: 1) Current, Active Membership by CCE, 2) Distribution of Active Members in NYMA by Member Type, 3) Current Active Membership by Type and Age, 4) Most Common Conditions by Member Type, 5) # Members with Certs by Care Suite and Location, 6) Demographic Information Changes by Month/Year, 7) Demographic Updates performed per Week in the Last Year

- Member Utilization: 1) Claims and Claim Lines Submitted per Month and by Benefit Plan, 2) Claims per Member per Month over Last 3 Years, 3) General Utilization Management Stats per Month, 4) Annual PA3 Volume by Type

- Internal & External Communications: 1) Overview of Outbound Mail, 2) Outbound Mail by Type, 3) Overall Incoming Mail Volume, 4) Incoming Mail Volume by Type

-Call Center: 1) Overall Call Statistics per Month and Year over the Last Three Years by Service Request Language and Language Line Usage, 2) Inbound Call Volume throughout the Year by Week, Day, and Time of Day, 3) Average Call Duration for the Year by Day of the Week and Time of Day, 4) Inbound Call Volume by Month/Year and Call Topic

- Provider Network: 1) Distribution Of NYMA Providers, Specialty, and Members by Zip Code, 2) Distribution of NYMA Provider Specialty and Related Member Treatment Needs by Zip Code, 3) # New Providers Enrolled and Trained by CCE, 4) Communications sent to NYMA External Providers by Type

- Claims Processing & Payment: 1) Overview of NYMA-Submitted Claim Volume by Month, 2) Summary of NYMA Claims Processed by Status and Decision, 3) Overview of NYMA Claims Volume and Processing per CCE, 4) Overview of NYMA Claims Payment (outgoing), 5) Clearinghouses Currently Used by the Program, 6) Most Common Claims-related Inquiries from NYMA Providers over the Past Year

- Pharmacy Formulary Assignment: 1) Current Pharmacy Formulary Status for Active Members, 2) Changes in Pharmacy Formulary Assignments over Time

- Other Health Insurance: 1) Most Common Types of Other Health Insurance for Members, 2) Breakdown of OHI Features Among Member Population, 3) Overall COB Statistics for NYMA Member Population

Supplementary Content:

- NPN (Optional Task): 1) Nationwide Distribution of Providers, Specialty, and Members by State, 2) Overview of NPN-Submitted Claim Volume by Month, 3) Summary of NPN Claims Processed by Status and Decision, 4) Overview of NPN Claims Volume and Processing per CCE, 5) Overview of NPN Claims Payment (outgoing)

- Additional Demographic Details: 1) # New Certifications by Age Group and Gender per Month over Last 3 Years, 2) # New Certifications by Member Type per Month over Last 3 Years, 3) New Certifications over Time by Member Type and Zadroga Category

CurrentDataExchanges

Enrollment

CCEAssignment&Transfer

DR_Processing

CertTrends&Processing