HomeMy WebLinkAboutRESPONSE - RFP - 7649 DENTAL ADMINISTRATOR (23)Delta Dental’s Sample
Standard Reporting Package
Standard Reports Listing
Name and Description Frequency
1 Quick Look Report
Shows the most frequently requested group summary information: premium, paid claims, and
enrollment by month, for the current and prior reporting periods.
2 Claim Summary Report
Provides detailed information on claims submitted (e.g. number of claims paid, average
enrollment, average cost per employee/member) for the current and prior reporting periods.
3 Member Age Distribution Report
Shows a graph of enrolled members by age for the last month of the current and prior
reporting periods.
4 Network Utilization Comparison
Shows the number, submitted charges, and paid amount of claims to Delta Dental PPO, Delta
Dental Premier, DeltaCare, and non-network providers (as applicable) for the current
reporting period.
5 Dentist Payment Distribution Report
Profiles which dentists have been utilized the most based on total claims dollars paid for the
current reporting period. The number of claims per dentist is also included.
6 Cost Containment Report
Details each cost containment feature of Delta Dental’s comprehensive cost management
program, and provides specific dollar figures and percentages of savings accrued within each
category (e.g. Network Savings, Consultant Review) for the current and prior reporting
periods. A graph of total submitted charges, containment savings, and paid claims is also
included.
7 Claims Utilization Report
Provides a detailed breakdown of how dental benefit dollars have been applied over a
specified period according to service categories (e.g. Diagnostic and Preventive, Major
Restorative). Average cost per procedure and cost per member by coverage category is also
included.
8 Claims Utilization by Member Report
This text format report contains both measures — treatment cost and number of treatments
by member type
9 Claims Utilization by Network Report
This text format report contains dollars saved and percent of all dollars for each network and
across all networks, for each of the treatment categories. It also contains totals across all
networks
10 Demographics and Financials: Member Demographics
This report contains for each month, all the various member demographic measures in one
place, with totals by member type and by subgroup, across the selected range of months.
11 Demographics and Financials: Rate Code Demographics
This report contains for each month, all the various rate codes demographic measures in one
place, with totals by subgroup, across the selected range of months.
12 Demographics and Financials: Claims and Premium Demographics
The report contains, for each month, the number of subscribers, number of claims, claims
paid dollars, premium paid dollars and admin fee paid dollars across the selected range of
months
13 Claims Incurred and Claims Paid Report
This report shows the lag between the month the claim was incurred (the date of service) and
the month the claim was paid. The column headings represent the month in which the claim
was incurred and row headings represent the month in which the claim was paid
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Standard Reports Listing
Name and Description Frequency
14 Performance of customer service and claims processing
This report shows several commonly requested and reported operations statistics for the most
recent calendar year. It contains data related to claims processing turnaround time and
accuracy, and data on customer service inquiries.
This is a static report based on Delta Dental of Colorado's Book of Business.
15 Provider Ranking
This report shows the Providers ranked according to the claims paid dollars and the visit
frequency by member type
16 Paid Claims Distribution by Provider type
This Pie Chart report shows the distribution of business between Par (Premier and PPO) and
Non-Par providers, based on how the claim was paid.
17 Par-NonPar Provider Report
This report shows by state, the distribution of business between Par (Premier and PPO) and
Non-Par providers, based on how the claim was paid. It also shows by member, the visit
count, procedure count and provider count.
Monthly
Monthly
Monthly
Monthly
ABC Company
Period: 01/01/2009 - 04/30/2009
Quick Look
Month Enrollment Claims Admin Fees
January, 2009 527 $37,521.61 $1,799.01
February, 2009 527 $31,688.82 $1,823.50
March, 2009 530 $27,061.72 $3,738.00
April, 2009 531 $28,975.70 $0.00
Total 2,115 $125,247.85 $7,360.51
Average 529
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Claims Summary Report
01/01/2008 - 04/30/2008 01/01/2009 - 04/30/2009 Variance
Total Claims Submitted ($) $231,730 $257,684
Total Claims Paid ($)
Total Cost Containment Savings
$116,774 $125,248
$114,956 $132,436
The Delta Dental Difference*
Total Claims Paid (#)
Average Cost per Claim
Average Employees Enrolled
Average Claims dollars per Employee
Average Claims Paid per Employee
Cost Savings/Employee
Total Premiums $0 $0
493 529
11.2%
7.3%
15.2%
5.0%
2.1%
7.3%
-0.0%
-2.1%
7.4%
0.0%
894 939
$130.62 $133.38
$236.86 $236.76
1.8 1.8
$233.18 $250.35
*Network Savings, Consultant Review, Contract Limitations, Non-Billable Services
$55,735 $62,040 11.3%
Total Admin Fees $6,846 $7,361 7.5%
Average Members Enrolled 1,303 1,345 3.2%
Submitted
Paid
01/01/2008 - 04/30/2008 01/01/2009 - 04/30/2009
0
50,000
100,000
150,000
200,000
250,000
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Member Age Distribution Report
April 2008 April 2009
0-18 19-24 25-34 35-44 45-54 55-64 65+
0.0
2.5
5.0
7.5
10.0
12.5
15.0
17.5
20.0
22.5
25.0
27.5
30.0
Percent (%)
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Delta Dental Network Total Submitted % Total Paid % # of Claims %
Avg Cost
per Claim
Network Utilization Comparison for 01/01/2009 - 04/30/2009
Delta Dental PPO $251,706 97.7% $125,248 100.0% 928 98.5% $134.97
Delta Dental Premier $4,310 1.7% $0 0.0% 6 0.6% $0.00
Non-Participating $1,668 0.6% $0 0.0% 8 0.8% $0.00
Total Utilization $257,684 100.0% $125,248 100.0% 942 100.0% $132.96
Delta Dental PPO
Delta Dental Premier
Non-Participating
1%
1%
99%
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Dentist Payment Distribution Report
A review of the highest volume dentists from 01/01/2009 - 04/30/2009
Rank Name
Delta Dental
Network State Paid Claims
Percentage of
Total Paid
Number of
Claims
1 CALDWELL, MICHELLE Delta Dental PPO CO $4,011 3.2% 31
2 LOPEZ, AVERY Delta Dental PPO CO $2,731 2.2% 19
3 MALOY, SHAWN Delta Dental PPO CO $2,304 1.8% 19
4 BOBAK, VOYTEK Delta Dental PPO CO $1,670 1.3% 19
5 NICOLETTE, JOHN Delta Dental PPO CO $2,546 2.0% 16
6 SCOTT, DANIEL Delta Dental PPO CO $1,040 0.8% 16
7 RUDMAN, ROBERT Delta Dental PPO CO $3,087 2.5% 15
8 MARTIN, SARIRA Delta Dental PPO CO $1,024 0.8% 15
9 MEYER, M WILLIAM Delta Dental PPO CO $1,180 0.9% 13
10 TSUMURA, KURT Delta Dental PPO CO $1,335 1.1% 12
11 MADLANG, CESAR Delta Dental PPO CO $1,305 1.0% 12
12 MILAUSNIC, MICHAEL Delta Dental PPO CO $1,612 1.3% 11
13 BELLON, MICHAEL Delta Dental PPO CO $2,082 1.7% 10
14 DUQUETTE, DOUGLAS Delta Dental PPO CO $644 0.5% 10
15 DURYEA, MICHAEL Delta Dental PPO CO $562 0.4% 10
16 NELSON, BRYAN Delta Dental PPO CO $1,090 0.9% 9
17 TOMASETTI, DAVID Delta Dental PPO CO $840 0.7% 9
18 WEDDLE JR, LARRY Delta Dental PPO CO $636 0.5% 9
19 SAYDYK, THEODORE Delta Dental PPO CO $572 0.5% 9
20 EDLUND, DAVID Delta Dental PPO CO $3,082 2.5% 8
21 FLOOD, PATRICK Delta Dental PPO CO $1,811 1.4% 8
22 BERNARDY, JEFFREY Delta Dental PPO CO $1,788 1.4% 8
23 WEYMAN, PAUL Delta Dental PPO CO $1,574 1.3% 8
24 NIELSON, KIRK Delta Dental PPO CO $1,035 0.8% 8
25 SANDERSON, STUART Delta Dental PPO CO $978 0.8% 8
Total $40,538 32.4% 312
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Cost Containment Report
01/01/2008 - 04/30/2008 01/01/2009 - 04/30/2009
Dollars Submitted
Procedures Submitted
$231,730 $257,684
2,337 2,584
Dollars Saved % of Billed Charges Dollars Saved % of Billed Charges
Less Cost Containment Features:
Network Savings $41,992 $47,390
Consultant Review
Non-Billable Services
Contractual Limitations
Total Delta Dental Difference
Optional Services
Coordination of Benefits
Non-Covered Services
Eligibility Verification
A. Total Containment Features:
Less Administrative Limitations:
Deductible
Patient Responsibility
Maximum Exceeded
B. Total Administrative Limitations
Total Containment (A+B)
Total Containment per Employee/Month
Total Plan Paid
$1,329
$9,535
$2,879
$0
$8,608
$11,280
$8,484
$3,320
$27,529
$0
$990
$8,622
$5,038
$909
$16,585
$12,497
$2,898
$4,145
$33,121
$241
$55,735 $62,040
$84,107 $94,929
$30,849 $37,507
$114,956 $132,436
$116,774 $125,248
$58.26 $62.62
18.1%
50.4%
49.6%
13.3%
0.0%
11.9%
1.4%
ABC Company
Cost Containment Report
Total Containment Features Total Administrative Limitations Total Plan Paid
50%
36%
13%
01/01/2008 - 04/30/2008
Total Containment Features Total Administrative Limitations Total Plan Paid
49%
37%
15%
01/01/2009 - 04/30/2009
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Cost Containment Report
Delta Dental Difference C.O.B. Non-Covered Services Eligibility Verification
4%
16%
1%
79%
01/01/2009 - 04/30/2009
Cost Containment Features
Deductible Patient Responsibility Maximum Exceeded
1%
88%
11%
01/01/2009 - 04/30/2009
Administrative Limitations
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Cost Containment Report Description
Purpose
This report singles out each cost containment feature of Delta Dental’s comprehensive cost management program, and provides specific dollar figures and
percentages of savings accrued within each category.
Description
Cost containment efforts provide savings not only to the purchaser of the dental benefit program, but to the covered individual as well. The report includes
savings from both participating and non-participating dentists' services.
Explanation of Terms
¾ Network Savings (Delta Dental Difference)–Dollars saved from reduction in submitted fees to reflect the participating dentist’s fee as filed with
Delta Dental or the maximum plan allowance, the balance of which is not chargeable to the patient by the participating dentists.
¾ Consultant Review (Delta Dental Difference)–Savings directly attributable to the clinical determination made by Delta Dental’s internal & external
(regional) consultants.
¾ Contract Limitations (Delta Dental Difference)–Delta Dental’s state-of-the-art computer system allows us to monitor benefit levels of every contract
closely to ensure that payment is made strictly within prescribed limits.
¾ Non-Billable (Delta Dental Difference)–Savings from procedures not chargeable to patient or the group contract by the participating dentists.
¾ C.O.B.–Dollars saved by Delta Dental’s special attention to properly applying our Coordination of Benefits policies. COB savings is the
difference between what Delta Dental would have paid without the COB minus what was paid.
¾ Optional Services–Savings from administrative determinations made by Delta Dental for the most cost-effective dentally acceptable
alternative procedures.
¾ Non-Covered Services–Savings from procedures chargeable to the patient but excluded or limited by the group contract (not including
amounts over contract maximums, co-payments and deductibles).
¾ Eligibility Verification – Benefit denials for procedures rendered during a period of patient ineligibility under the plan.
ABC Company
Claims Utilization Report
Coverage Category Procedures
Paid PMPM
Total Amount
Paid
% Paid
PMPM
Procedures
Paid PMPM
Total Amount
Paid
% Procedures
Paid PMPM
Paid
PMPM
Total Amt
Paid
Paid
PMPM
01/01/2008 - 04/30/2008 01/01/2009 - 04/30/2009 Percent Change from Prior
Diagnostic 0.166 $25,279 21.6% $4.85 0.152 $26,523 21.2% $4.93 -8.1% 4.9% 1.6%
Preventive 0.073 $19,344 16.6% $3.71 0.075 $19,911 15.9% $3.70 3.8% 2.9% -0.3%
Restorative (Basic) 0.033 $12,542 10.7% $2.41 0.042 $15,622 12.5% $2.90 26.5% 24.6% 20.6%
Restorative (Major) 0.012 $11,536 9.9% $2.21 0.012 $11,126 8.9% $2.07 -1.6% -3.6% -6.6%
Endodontics 0.003 $9,029 7.7% $1.73 0.004 $11,550 9.2% $2.15 29.1% 27.9% 23.9%
Periodontics 0.015 $8,161 7.0% $1.57 0.013 $7,312 5.8% $1.36 -9.5% -10.4% -13.2%
Prosthodontics 0.000 $660 0.6% $0.13 0.002 $4,435 3.5% $0.82 529.6% 572.0% 550.9%
Implant Services 0.000 $0 0.0% 0.00 0.000 $396 0.3% $0.07 0.0% 0.0% 0.0%
Oral Surgery 0.010 $5,227 4.5% $1.00 0.013 $6,898 5.5% $1.28 32.3% 32.0% 27.8%
Orthodontics 0.048 $23,892 20.5% $4.58 0.036 $19,696 15.7% $3.66 -24.1% -17.6% -20.2%
Miscellaneous 0.002 $1,104 0.9% $0.21 0.003 $1,779 1.4% $0.33 34.1% 61.1% 56.1%
Total 0.362 $116,774 100 % $22.40 0.355 $125,248 100 % $23.28 -2.1% 7.3% 3.9%
Amount Paid Prior Period
1%
20%
4%
1%
7%
8%
10%
22%
17%
11%
Amount Paid Current Period
Diagnostic
Preventive
Restorative (Basic)
Restorative (Major)
Endodontics
Periodontics
Prosthodontics
Implant Services
Oral Surgery
Orthodontics
Miscellaneous
1%
16%
6%
0%
Claims Utilization Report - Description
Purpose
This report provides a detailed breakdown of how dental benefit dollars have been applied over a specified period according to service categories.
Description
Eleven categories, or “procedure classes”, are included in this dollar analysis, including:
¾ Diagnostic–examination, x-rays
¾ Preventive–prophylaxis, fluoride treatments
¾ Restorative (Basic)–amalgam (silver) and composite (white) restorations (fillings)
¾ Endodontic–pulpal therapy, root canals
¾ Periodontic–treatment to gums and supporting bone
¾ Oral Surgery–extraction and oral surgery procedures
¾ Restorative (Major)–crown services
¾ Prosthodontic–bridges, partial and complete dentures
¾ Orthodontic–braces
¾ Misc.–general procedures including anesthesia, consultations
¾ Implant Services - implants
01/01/2009 - 04/30/2009
ABC Company
Claims Utilization by Member Report
Coverage Category
Subscriber
Claims Paid
Amount
Subscriber
Procedure
Count
% of
Total
Amt
Spouse
Procedure
Count
Spouse Claims
Paid Amount
Dependent
Claims Paid
Amount
Dependent
Procedure
Count
Total Claims Paid
Amount
Total
Procedure
Count
1. Diagnostic $11,731.00 367 $5,576.00 160 $9,216.00 293 21.2% $26,523.00 820
2. Preventive $7,747.00 134 $4,059.00 72 $8,105.00 200 15.9% $19,911.00 406
3. Restorative (Basic) $6,168.00 95 $5,418.10 73 $4,036.00 58 12.5% $15,622.10 226
4. Restorative (Major) $7,819.50 41 $3,298.40 20 $8.50 1 8.9% $11,126.40 62
5. Endodontics $7,623.20 16 $3,559.00 7 $368.00 1 9.2% $11,550.20 24
6. Periodontics $4,643.00 52 $2,617.80 17 $51.20 2 5.8% $7,312.00 71
7. Prosthodontics $3,041.30 10 $1,394.00 3 $0.00 0 3.5% $4,435.30 13
8. Implant Services $0.00 0 $395.50 1 $0.00 0 0.3% $395.50 1
9. Oral Surgery $1,914.00 22 $1,301.90 16 $3,681.60 33 5.5% $6,897.50 71
10. Orthodontics $2,247.00 23 $733.50 11 $16,715.35 162 15.7% $19,695.85 196
11. Miscellaneous $597.00 6 $64.00 1 $1,118.00 11 1.4% $1,779.00 18
Total
359 209 371 939
$53,531.00 $28,417.20 $43,299.65 $125,247.85
$149.11 $135.97 $116.71 $133.38
766 381 761 1,908
Total Claims Paid Count
Average Claim Paid Amt
100.0%
% of Total 43% 40% 23% 20% 35% 40%
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Claims Utilization by Network Report
01/01/2009 - 04/30/2009
Network and Coverage Category Claims Paid Amount Procedure Count % of Total Amt
Delta Dental PPO
1. Diagnostic $26,523.00 820 21.2%
2. Preventive $19,911.00 406 15.9%
3. Restorative (Basic) $15,622.10 226 12.5%
4. Restorative (Major) $11,126.40 62 8.9%
5. Endodontics $11,550.20 24 9.2%
6. Periodontics $7,312.00 71 5.8%
7. Prosthodontics $4,435.30 13 3.5%
8. Implant Services $395.50 1 0.3%
9. Oral Surgery $6,897.50 71 5.5%
10. Orthodontics $19,695.85 196 15.7%
11. Miscellaneous $1,779.00 18 1.4%
$125,247.85
928
1,908
100.0%
$134.97
Total
% of Grand Total Amt
Total Claims Paid Count
Average Claim Paid Amt
100.0%
100.0%
Grand Total
1. Diagnostic $26,523.00 820 21.2%
2. Preventive $19,911.00 406 15.9%
3. Restorative (Basic) $15,622.10 226 12.5%
4. Restorative (Major) $11,126.40 62 8.9%
5. Endodontics $11,550.20 24 9.2%
6. Periodontics $7,312.00 71 5.8%
7. Prosthodontics $4,435.30 13 3.5%
8. Implant Services $395.50 1 0.3%
9. Oral Surgery $6,897.50 71 5.5%
10. Orthodontics $19,695.85 196 15.7%
11. Miscellaneous $1,779.00 18 1.4%
$125,247.85
942
1,908
100.0%
$132.96
Grand Total
% of Grand Total Amt
Grand Total Claims Paid Count
Average Claim Paid Amt
100.0%
100.0%
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Month Group Sub Division Division Relationship Age Band Member
Count
ABC Company
01/01/2009 - 04/30/2009
Demographics and Financials: Member Demographics Report
01/31/2009 000000000 00000000 0000 Subscriber 0-18 1 1...
19-24 20 1...
25-34 90 1...
35-44 137 1...
45-54 178 1...
55-64 95 1...
65+ 6 1...
Subscriber Total 527
Spouse/Partner 19-24 3 1...
25-34 58 1...
35-44 93 1...
45-54 130 1...
55-64 56 1...
65+ 6 1...
Spouse/Partner Total 346
Dependent 0-18 398 1...
19-24 74 1...
25-34 1 1...
Dependent Total 473
Subgroup Total 1,346
02/28/2009 000000000 00000000 0000 Subscriber 0-18 1 2...
19-24 20 2...
25-34 92 2...
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Month Group Sub Division Division Relationship Age Band Member
Count
ABC Company
01/01/2009 - 04/30/2009
Demographics and Financials: Member Demographics Report
35-44 137 2...
45-54 177 2...
55-64 95 2...
65+ 5 2...
Subscriber Total 527
Spouse/Partner 19-24 3 2...
25-34 57 2...
35-44 93 2...
45-54 126 2...
55-64 61 2...
65+ 5 2...
Spouse/Partner Total 345
Dependent 0-18 397 2...
19-24 72 2...
25-34 1 2...
Dependent Total 470
Subgroup Total 1,342
03/31/2009 000000000 00000000 0000 Subscriber 0-18 1 3...
19-24 24 3...
25-34 92 3...
35-44 134 3...
45-54 179 3...
55-64 95 3...
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Month Group Sub Division Division Relationship Age Band Member
Count
ABC Company
01/01/2009 - 04/30/2009
Demographics and Financials: Member Demographics Report
65+ 5 3...
Subscriber Total 530
Spouse/Partner 19-24 5 3...
25-34 56 3...
35-44 92 3...
45-54 127 3...
55-64 61 3...
65+ 5 3...
Spouse/Partner Total 346
Dependent 0-18 396 3...
19-24 70 3...
25-34 1 3...
Dependent Total 467
Subgroup Total 1,343
04/30/2009 000000000 00000000 0000 Subscriber 19-24 23 4...
25-34 92 4...
35-44 133 4...
45-54 183 4...
55-64 95 4...
65+ 5 4...
Subscriber Total 531
Spouse/Partner 19-24 5 4...
25-34 55 4...
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Month Group Sub Division Division Relationship Age Band Member
Count
ABC Company
01/01/2009 - 04/30/2009
Demographics and Financials: Member Demographics Report
35-44 92 4...
45-54 128 4...
55-64 62 4...
65+ 6 4...
Spouse/Partner Total 348
Dependent 0-18 394 4...
19-24 76 4...
25-34 1 4...
Dependent Total 471
Subgroup Total 1,350
Period Total 01/01/2009 to 04/30/2009 000000000 00000000 0000 Subscriber 0-18 3 1...
19-24 87 1...
25-34 366 1...
35-44 541 1...
45-54 717 1...
55-64 380 1...
65+ 21 1...
Subscriber Total 2,115
Spouse/Partner 19-24 16 1...
25-34 226 1...
35-44 370 1...
45-54 511 1...
55-64 240 1...
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Month Group Sub Division Division Relationship Age Band Member
Count
ABC Company
01/01/2009 - 04/30/2009
Demographics and Financials: Member Demographics Report
65+ 22 1...
Spouse/Partner Total 1,385
Dependent 0-18 1,585 1...
19-24 292 1...
25-34 4 1...
Dependent Total 1,881
Subgroup Total 01/01/2009 to 04/30/2009 5,381
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Month Group Sub Division Division Rate Code and Description Subscriber
Count
ABC Company
Demographics and Financials: Rate Code Demographics Report
01/01/2009 - 04/30/2009
01/31/2009 000000000 00000 01 - Subscri 132 1...
02 - Subscriber plus Spouse 136 1...
05 - Subscriber plus Child 34 1...
06 - Subscriber plus Children 15 1...
03 - Subscriber plus Family 210 1...
Subgroup Total 527
02/28/2009 0000000000 0000 01 - Subscriber 134 2...
02 - Subscriber plus Spouse 136 2...
05 - Subscriber plus Child 35 2...
06 - Subscriber plus Children 13 2...
03 - Subscriber plus Family 209 2...
Subgroup Total 527
03/31/2009 000000000 00000000 0000 01 - Subscriber 137 3...
02 - Subscriber plus Spouse 138 3...
05 - Subscriber plus Child 33 3...
06 - Subscriber plus Children 14 3...
03 - Subscriber plus Family 208 3...
Subgroup Total 530
04/30/2009 000000000 00000000 0000 01 - Subscriber 136 4...
02 - Subscriber plus Spouse 138 4...
05 - Subscriber plus Child 33 4...
06 - Subscriber plus Children 14 4...
03 - Subscriber plus Family 210 4...
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Month Group Sub Division Division Rate Code and Description Subscriber
Count
ABC Company
Demographics and Financials: Rate Code Demographics Report
01/01/2009 - 04/30/2009
Subgroup Total 531
Period Total 01/01/2009 to 04/30/2009 000000000 00000000 0000 01 - Subscriber 539 1...
02 - Subscriber plus Spouse 548 1...
05 - Subscriber plus Child 135 1...
06 - Subscriber plus Children 56 1...
03 - Subscriber plus Family 837 1...
Subgroup Total 01/01/2009 to 04/30/2009 2,115
Report Date: 05/19/2009
Master: 000000000-00000000-0000
ABC Company
Demographics and Financials: Claims and Premiums Demographics Report
01/01/2009 - 04/30/2009
Month Group Sublocation Division Subscriber
Count
Claims
Count
Claims Paid
Amount
Premium Paid
Amount
Admin Fee Paid
Amount
01/31/2009 000000000 00000000 0000 1...
527 258 $37,521.61 $0.00 $1,799.01
02/28/2009 000000000 00000000 0000 2...
527 230 $31,688.82 $0.00 $1,823.50
03/31/2009 000000000 00000000 0000 3...
530 215 $27,061.72 $0.00 $3,738.00
04/30/2009 000000000 00000000 0000 4...
531 236 $28,975.70 $0.00 $0.00
Period Total 01/01/2009 through 04/30/2009 2,115 939 $125,247.85 $0.00 $7,360.51
Report Date: 05/19/2009
Master: 000000000-00000000-0000
01/01/2009 - 04/30/2009
Claims Incurred and Claims Paid Report
ABC Company
Incurred Month
04/30/2009 03/31/2009 02/28/2009 01/31/2009 12/31/2008 11/30/2008 10/31/2008 09/30/2008 08/31/2008 07/31/2008 06/30/2008 05/31/2008 04/30/2008 03/31/2008 02/29/2008 01/31/2008 12/31/2007
11/30/2007 10/31/2007 09/30/2007 08/31/2007 07/31/2007 06/30/2007 05/31/2007
Paid Month Total Paid
Before
05/31/2007
04/30/2009 $16,637 $9,319 $1,914 $1,034 $72 $28,976
03/31/2009 $19,368 $6,821 $262 $568 $43 $27,062
02/28/2009 $20,976 $10,738 -$25 $31,689
01/31/2009 $26,030 $9,451 $159 $1,742 $84 $55 $37,522
Total Incurred $16,637 $28,687 $29,711 $38,064 $10,066 $159 $1,742 $43 $0 $0 $84 $0 $0 $0 $0 $55 $0 $0 $0 $0 $0 $0 $0 $0 $0 $125,248
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Operational Measures
Q1 Q2 Q3 Q4 YTD
Average Speed of Answer - Inc. IVR 0:10 0:10 0:14 0:17 0:13
Telephone Abandonment - Inc. IVR 1.30% 1.22% 1.60% 2.08% 1.55%
% Claims Processed in 10 days 96.77% 98.98% 99.40% 98.93% 98.52%
Financial Accuracy 100% 100% 100% 100% 100%
Claims Accuracy 100% 100% 100% 100% 100%
Q1 Q2 Q3 Q4 YTD
Average Speed of Answer - Inc. IVR 0:13 0:13
Telephone Abandonment - Inc. IVR 1.61% 1.61%
% Claims Processed in 10 days 99.30% 99.30%
Financial Accuracy 100% 100%
Claims Accuracy 100% 100%
2008
2009
Delta Dental of Colorado
4-3-09
01/01/2009 - 04/30/2009
ABC Company
Paid Claims Distribution By Provider Type Report
Delta Dental PPO
$125,248
100%
Report Date: 05/19/2009
Master: 000000000-00000000-0000
State Network Relationship Visit Count Claims Count Paid Procedure
Count Claims Paid Amount Provider Count
01/01/2009 - 04/30/2009
ABC Company
Par - NonPar Provider Report
AZ Delta Dental PPO Dependent 5 5 5 $280.00 2
CO Delta Dental PPO Subscriber 332 355 766 $53,531.00 159
Spouse/Partner 183 202 378 $28,293.20 91
Dependent 353 364 756 $43,019.65 115
Subtotal for CO - Delta Dental PPO 868 921 1,900 $124,843.85 365
Delta Dental Premier Subscriber 2 2 0 $0.00 2
Spouse/Partner 2 2 0 $0.00 2
Dependent 2 2 0 $0.00 2
Subtotal for CO - Delta Dental Premier 6 6 0 $0.00 6
Non-Participating Subscriber 3 5 0 $0.00 3
Spouse/Partner 3 3 0 $0.00 3
Subtotal for CO - Non-Participating 6 8 0 $0.00 6
Subtotal for CO 880 935 1,900 $124,843.85 377
ID Delta Dental PPO Spouse/Partner 2 2 3 $124.00 1
Period Total Delta Dental PPO Subscriber 332 355 766 $53,531.00 159
Spouse/Partner 185 204 381 $28,417.20 92
Dependent 358 369 761 $43,299.65 117
Delta Dental Premier Subscriber 2 2 0 $0.00 2
Spouse/Partner 2 2 0 $0.00 2
Dependent 2 2 0 $0.00 2
Non-Participating Subscriber 3 5 0 $0.00 3
Spouse/Partner 3 3 0 $0.00 3
Period Total 01/01/2009 through 04/30/2009 887 942 1,908 $125,247.85 380
Report Date: 05/19/2009
Master: 000000000-00000000-0000
4%
6%
9%
9%
21%
16%
12%
Report Date: 05/19/2009
Master: 000000000-00000000-0000
36.3%
3.7%
4.9%
3.7%
0.0%
24.1%
1.2%
4.1%
0.6%
18.4%
48.6%
51.4%
14.6%
0.1%
12.9%
1.6%
36.8%
1.1%
4.8%
6.4%
0.4%
24.1%
2.0%
3.3%
0.4%
Report Date: 05/19/2009
Master: 000000000-00000000-0000
Monthly
Monthly
Monthly