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June 14, 2000 <br />Medical Claim Administration / Utilization Review l Managed Cam / Large Case <br />Management <br />Reason for selection of Blue Cross. Blue Cross provides the overall lowest cost for both the <br />expected claims analysis and the maximum cost analysis for the County. Their claims administration <br />cost includes claim handling, network management, utilization review, large case management. <br />managed care and prescription management. Their network comprises 85% of providers in Indian <br />River County and their fee structure agreement with providers eliminates the possibility of employees <br />being billed for charges not paid for under the Blue Cross fee schedule. A comparison of claim <br />payment codes shows that the maximum charges allowed under the Blue Cross fee schedule are <br />considerably less than fee schedules used by other proposers. The result is a lower overall cost <br />projection for the County's Self-insured Plan. The modified Blue Cross proposal assumes <br />implementation of pending plan changes by the County. <br />Other proposers did not offer such a large network or analysis did not produce a lower overall cost. <br />Indian River County <br />Health Plan Claims Administration Services <br />Third Party <br />Adminbtrator <br />BCBS <br />McCreary <br />Brown & <br />Brown <br />Robey <br />Barber <br />PBA <br />PAI <br />Innovative <br />Medial <br />Solntioas <br />Account <br />Representative <br />Grokhowsky <br />B. Bane <br />Macombe <br />r <br />TBA <br />Hargrove <br />K.Gratiois <br />GBA <br />What services are <br />included? <br />Claim Ad, <br />Network <br />UR,CM, <br />MC & RX <br />Claim Ad, <br />Network <br />UR,CM, <br />MC & RX <br />Claim Ad, <br />Network <br />UR,CM <br />MC <br />Claim Ad, <br />Network <br />UR,CM, <br />MC & RX <br />Claim Ad <br />RX <br />Claim Ad <br />Claim Ad <br />Network <br />UR, RX <br />is network proposed? <br />If so, is directory <br />included? <br />Yes <br />Yes <br />Yes <br />No <br />No <br />Yes <br />Yes <br />No <br />Out of area hospital <br />access <br />Countrywide <br />Network <br />Yes <br />Yes <br />Not <br />attached <br />No <br />Yes <br />Yes <br />Centers of Excellency <br />Included <br />Not <br />included <br />Not <br />available <br />Not <br />attached <br />No <br />Not <br />available <br />Yes. <br />Provide Actuarial <br />assistance? <br />No <br />No <br />Yes <br />No <br />No <br />No <br />Yes. <br />Actuarial worksheets <br />& calculation <br />available to county? <br />No <br />No <br />Yes <br />No <br />No <br />No <br />Yes. <br />Is actuarial cost <br />included? <br />No <br />No <br />Yes <br />No <br />No <br />No <br />No <br />Avg. Turnaround for <br />claims <br />10 days <br />92% <br />10 days <br />10 days <br />10-15 days <br />5-10 days <br />28 days <br />10 days <br />(85%) <br />Average error ratio <br />performance <br />& <br />3% <br />2-4% <br />3% <br />I% <br />I% <br />1% <br />1% <br />6 <br />biz <br />sad' <br />