ounty FFM byCounty % Subsidizedby % CSRbyCounty County Towns Membership 4,278n 208 200 Rabun 513 White Habersham 1,437 1,058 Stephens 330 Hall Banks Franklin Hart4,278 360 166 112 Jackson 234 Barrow 135
In GroupStatistics MembershipbyCounty GroupMembershipby IFPbyCou Countydi..Federally-FacilitatedMarketplace(FFM) MembershipbyCountyDade Catoosa Fannin Union360 1,479 489 406 Walker Whitfield Murray Gilmer 1,566 2,302 794 805 Chattooga Gordon Pickens Lumpkin 512 1,176 802 628 Dawson 429 Floyd Bartow Cherokee Forsyth 2,279 228 448 408 Polk 958 Haralson 220 Carroll 905 Heard 75
ounty FFM byCounty % Subsidizedby % CSRbyCounty County Membership 3,797 175 Towns Rabunon 193 4826 White 1,338 Habershamin 961 Stephens 316 Hall Banks Franklin Hart3,797 336 163 107 Jackson 208 Barrow 132
In GroupStatistics MembershipbyCounty GroupMembershipby IFPbyCou Countydi..% SubsidizedbyCounty(FFM MembershipOnly) Dade Catoosa Fannin Un91.67% 91.14% 92.02% 93. Walker Whitfield Murray Gilmer 91.32% 93.40% 94.08% 93.42%Chattooga Gordon Pickens Lump 91.99% 92.01% 91.02% 91.56 Floyd Bartow Dawson 88.50% 82.46% 93.71% Cherokee Forsyth 76.56% 60.78% Polk 95.09% Haralson 97.73% Carroll 93.81% Heard 96.00%
ounty FFM byCounty % Subsidizedby % CSRbyCounty County % FFM Subsidized Towns 0.8200 0.9700 97.41%Union Rabun3.84% 89.63% White Habersham 95.74% 93.86% Stephens 92.09% pkin.56% Hall Banks Franklin Hart 91.62% 93.15% 95.71% 93.46% Jackson 75.48% Barrow 84.85%
In GroupStatistics MembershipbyCounty GroupMembershipby IFPbyCou Countydi.. % onCSRVariantsbyCounty (FFM MembershipOnly) Dade Catoosa Fannin Union65.00% 62.75% 62.37% 58.62% Walker Whitfield Murray Gilmer 66.48% 67.90% 75.94% 65.84%Chattooga Gordon Lumpkin 72.46% 66.92% 67.36% Floyd Bartow Pickens Dawson H 65.60% 52.63% 64.84% 65.97% 67. Cherokee Forsyth 49.55% 39.95% Polk 76.20% Haralson 66.36% Carroll 61.22% Heard 60.00%
ounty FFM byCounty % Subsidizedby % CSRbyCounty County Towns % FFM CSR 0.762067.88% 0.3995 Rabun 62.45% White Habersham74.96% 67.43% Stephens 63.61%Hall Banks Franklin Hart7.26% 72.62% 71.78% 65.42% Jackson 55.77%Barrow59.09%
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Human Resources &Corporate Compliance Sabrina LeBeau
HealthOne Alliance Headcount 2014January February March April May June July A 49 50 48 47 46 50 50 2015 September October November DecemberDaltonKennesaw 48 44 49 50TexasRemote 6 430Totals 11 11 11 11 667 65 65 69 68 2015 January February March April May June JFull Time 40 41 41 42Part Time No Benefits 38 39Part Time With Benefits 1 1 1 2Temporary 11 1 1 1 1Totals 2 2 3 4ADP FTE 11 44 45 46 49 44 44.67 45.91 46.03 22 42 43 42 42.2 2016 January February March April May June J January 51 55 54 54 55 54Dalton 11 11 11 11 10 10TexasRemote 7 8 7 6 6 6Totals 69 74 72 71 71 70 2016 February March April May June JFull Time 47 56 54 54 61 62Part Time No BenefitsPart Time With Benefits 2 2 2 2 3 3Temporary 1 1 1 1 2 2Totals 19 15 15 14 5 3 69 74 72 71 71 70 2017 January February March April May June J January 57 56 0 0 0 0Dalton 12 12Texas April May June JRemote 6 6Totals 75 74 0 0 0 0 2017 February MarchFull Time 58 58Part Time No BenefitsPart Time With Benefits 5 5Temporary 1 1Totals 11 10 75 74
August September October November December Total Average 47 46 46 47 46 572 47.6667 48July August September October November December 43 47 48 46 47 47 222222 111111 4 4 14 16 19 18 50 54 65 65 69 68 53.3333 52.2292 49.62 50.83 59.18 64.62 68.63 69.06July August September October November DecemberJuly 53 11 51 59 60 60 57 6 12 12 13 12 12 70 66 666 August 62 69 77 79 78 75 3 September October November December 2 3 61 61 63 61 58 70 34 555 21 111 3 11 10 11 11 69 77 79 78 75July August September October November DecemberJuly 0 00 000 August September October November December 000000
Open Position Department Managed CareManaged Care Contractor Quality AssuranceQuality Assurance Clinical ClaimsCoordinatorMedical Records CodingTechnicianFilled Position Department Hiring Manager IT Joe MaumusApplication Support Erin MaloneSpecialist Customer RelationsInternal Customer Misty MaddoxRelations Credentialing/NetworkRepresentative ManagementBroker/ProviderCredentialingSpecialistEventGrizzly Train RunEmployee Appreciation WeekBill Gregory Healthcare ClassicBirthday BashFamily PicnicOpen Enrollment Kick-Off DayThanksgiving LunchChristmas Party
Hiring Manager Date PostedCeleste Richards 2/3/2016Celeste Richards 10/13/2016Leslie Sprites 11/1/2016Date Posted Employee Start Date11/8/2016 Alessandro 2/13/201710/20/2016 Maldonado 2/13/2017 Krystal Tee12/19/2016 2/13/2017 Daisy KonterDateSaturday, March 11, 2017March 20-24, 2017Saturday, May 13, 2017Thursday, June 15, 2017July (date TBD)Tuesday, October 31, 2017Thursday, November 16, 2017Saturday, December 09, 2017
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ClaimsLeslie Sprites
Provider Specialty Service Request January Provider LSt. Mary's HospitalCanton Counseling Behavioral Health Robotic Sigmoid Resection Athens, GAAshley O'Shields MD Pediatric Therapy Canton, GAKevin Nguyen Surgery Pediatric Services Cumming,Joint Active Systems DME Hepatectomy; resection ofCurtis Koontz, MD Pediatric Surgery liver Atlanta, GARiver Point Behavioral Health Behavioral Health Knee Brace Effingham Lap/Coley Chattanoo IP Behavioral Health Jacksonvill YTD Summary TotalsMonth Total Requested Approved DeniedJanuary 3February 7MarchApril 73MayJuneJulyAugustSeptemberOctoberNovemberDecemberYTD TotalLimited Treatment Requests
y 2017 SP TicketLocation Member Type LTA Outcome Rate if Approved LTA OriginationA On Exchange Closed n/a Contracting 13783A On Exchange Denied n/a UM 13874 On Exchange, GA 3 Members Approved FS108 Contracting 13906 A On Exchange Denied n/a Customer Service 14043m, IL On Exchange Approved 100% M'care UM 14067 On Exchange Approved 10% discount UM 14068 oga, TN On Exchange Denied n/a UM 14126 le, FL Closed 1 3 31 2/6/2017
2017 YTD Savi Total Claims Total Allow Total Allowed (AllowMonth -Year Audited Total Charges without Audit after Audit Invoic Jan-17 Feb-17 6$ 2,319,898 $ 1,385,446 $ 1,179,715 $ Mar-17 Apr-17 6$ 2,319,898 $ 1,385,446 $ 1,179,715 $ May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17YTD Totals Savings by Facility - YTDFacility Savings Claims AuditedCHOA $ 49,915.53 1Floyd $ 74,217.50 1Kennestone $ 28,044.37 2Kindred $ 16,658.66 1Memorial $ 18,042.39 1Denied Pre-Screens by Facility - YTDFacility Claim CountGordon 1Redmond 1Emory 1Pre-Pay Audit Report
ings Summaryl Cost Total Invoice Total Audit Total Total Savingsw+ $ 18,853 Findings Findings after (Findings afterce) Contract contract - $ 357,438 applied invoice) 1,198,567 $ 186,878 $ 205,7311,198,567 $ 18,853 $ 357,438 $ 205,731 $ 186,878 2/6/2017
2017 Appeals and C Month Claim Appeals Provider Member 2 11January Total ReceivedFebruary 13MarchApril 13 2 11MayJuneJulyAugustSeptemberOctoberNovemberDecemberYTD Total Month DOI Complaints Provider Member 03January Total ReceivedFebruary 3MarchApril 3 03MayJuneJulyAugustSeptemberOctoberNovemberDecemberYTD TotalAppeals and Complaints Report
Complaint Summary MAC Other1 10 31 10 3 Quality Management & Improvement Standards Categories Appeals Complaints Access3 Attitude and Service 00 Billing and Financial Issues Quality of Care 01 Quality of Practitioner Office Site YTD Total 13 2 00 00 13 33 2/6/2017
Quality Assurance Lisa Johnston
NCQA -- The National Committee for Quality AssuranceThe accreditation body for Alliant Health Plans. Information packets are being assembled to distribute to each Department Head. These packets will list department compliance responsibilities for NCQA standards Documentation for 2016 is being finalized and tagged for 2017 standards Annual evaluation reports are being written and revised for: o 2016 BH Workgroup o 2016 Workplan o QI 8—Continuity and Coordination of Care of Medical Care o QI 9—Continuity and Coordination of Care between Medical and Behavioral Healthcare o 2016 QM Program Reports and documents are being created for: o 2017 BH Workgroup o 2017 Workplan o 2017 QM Program DescriptionBehavioral Health WorkgroupA workgroup designed to meet NCQA requirements to improve members’’ experience with behavioralhealthcare and service. Finalizing program objectives for 2017--working to align objectives with HEDIS for maximum use of time and resources Developing an educational initiative for PCPs and BH providers on the topic of Opioid Abuse to present early Q3CAHPS -- Consumer Assessment of Healthcare Providers and SystemsA survey used to measure and publicly report patients’ experiences with their health care plan andproviders Pre-fielding tasks completed o client materials completed and sent to SPH Analytics o survey tool has been audited and approved o formatted database uploaded Initial survey will be mailed out on 2/15/17 HOQ will be completed by 2/17/17HEDIS -- Healthcare Effectiveness and Data Information SetA set of performance measures for health plans that assesses areas of health plan care and service. Finalizing Roadmap documents Conducting weekly calls with Altegra (vendor) and ATTEST (auditor) On-going training occurring for documentation and portal use
Abstraction project has begun Upcoming events: Plan submits queries and final on-site agenda on 2/28/17 ATTEST will be on-site March 7th-9thHIPAA -- Health Insurance Portability and Accountability ActIts purpose is to provide health care coverage continuity, ensure greater accountability and simplifyadministrative functions within the health care industry. Summit Re breach: Issue log has been updated. No further word has been received from the OCR investigation Policies are being updated and reviewed; legal will return policies with suggested updates Educational conference will be held on March 29th-31st; in attendance, will be Lisa Johnston, Celeste Scott, Joe Maumus and Dave Zhang
RegulatoryCompliance Sara Travis
Policies and Procedures currently in progress:Effectuating Payments26 Year Old Aging off Parent Policy – Individual and GroupSpecial Enrollment Period – Individual and Group3rd Party PaymentsHICSBroker AppointmentEHB Formulary Monthly AuditAdverse Recommendation of ProviderConfidentiality and Record RetentionTransplant Evaluation Quantity AllowedPatient Safety Standards for QHP Issuers
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