Meeting Called to Order by Thomas Woodruff
Financials and Dashboard - Milliman presented the monthly dashboard report for financials. It was reported that the claims experience was running close to budget projection, however, the positive claims experience is being offset by an increase in active and retiree membership.
ER Audit Findings - United Healthcare/Oxford and Anthem both presented findings from the audit of Middlesex Hospital ER claims. The audit findings from both carriers included significant non-emergent use of ER by participants, facility up-coding of claims, and a lower use of ancillary services being used in the ER. The committee discussed whether a systematic edit could be put in place to deny the inappropriate charges.
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