Healthcare Access, Eligibility & Enrollment Unit (HAEEU)

% of Discrepancy Work Completed in 30 Days

100%Sep 2020

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Partners

DVHA-HAEEU partners with its three carrier partners (BlueCross BlueShield of Vermont, MVP Healthcare, and Northeast Delta Dental) as well as its premium processing contractor (Wex Health).

Story Behind the Curve

This metric looks at the number of discrepancies between the State's system and the systems of its carrier partners that are identified and should be worked within 30 days, then evaluates how many of those items actually are worked within the month. 

The ability to perform ongoing monthly reconciliation between the State's system and the systems of its carrier partners is essential to maintaining data integrity, ensuring a positive customer experience, and limiting financial liabilities. If the State and its partners can identify discrepancies that arise and address the vast majority of those discrepancies within the month, they will be in a strong position to avoid lingering inventories and the accompanying risks.

False positives and items related to the timing of reports are screened out. MVP Health Care needs to improve the quality of its reports in order to enable reconciliation, which is a priority for 2018 now that MVP has a new integration vendor in place as of the end of 2017. In June 2018, MVP completed the system work needed to support this reconciliation. DVHA and its reporting vendor then operationalized the process by fall. 

In December 2017, the reconciliation team reported that it had completed 100% of November discrepancy work -- all with the Blue Cross Blue Shield of Vermont and Northeast Delta Dental systems -- within 30 days, surpassing the 90% goal for the tenth straight month. 

Due to the way the monthly reconciliation process works within the annual process, there were no figures for January 2018. Metrics for 2018 monthly reconciliation are reported from February through December. The target for 2018 was increased to the goal of completing 100% of discrepancy work each month. This target has been met every month since February 2018.

Strategy

Utilize reports from insurance carrier partners and VHC system to identify potential discrepancies. If there are discrepancies, work with the relevant partner to correct and look for root cause.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy