ACHIA Operations Report

1 Monthly Operations ReportACHIA Operations ReportJuly 2017 Alaska Comprehensive Health Insurance AssociationLevels of ServiceAugust 2016 - July 2017 Levels of ServiceAug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Enrollment Clean Application Process100%100%100%100%100%100%100%100%1 00%100%100%100%100% ID Card Issuance100%100%100%100%100%100%100%100% 100%100%100%100%100% Paid-to Status Update100%100%100%100%100%100%100%100%10 0%100%100%100%100% Clean Claim Process100%100%100%100%100%100%100%100%1 00%100%100%100%100% Accuracy97%100% Accuracy98%100% Service Sec. Speed of Answer*45 sec Abandonment Rate*< 5% * Reporting began January 1, 2007 Measurement of StandardsStandard 1 - If the date received compared to the date approved for all clean applications approved during the reporting month is less than 2 - If the date received compared to the date mailed for all applications approved during the reporting month is less than 14-days from receipt of eligible application to issuance of identification 3 - 99% or greater accuracy rate for enrollment coding of premium, plan and age rate categories for all approved applications during the reporting 4 - 100% scoring of (10)

2 Member audit of 14-calendar days or less from premium receipt to update of eligibility file paid-to-statusStandard 5 - 99% scoring of (10) member audit of accuracy for posting of correct payment, implementation of rate changes and premium account reconciliations during the reporting 6 - 100% of clean claims processed within 30-calendar days during the reporting 7 - 97% or greater accuracy of a (20) claim audit for proper clerical coding of claims during the reporting month. Standard 8 - 98% or greater accuracy of a (20) claim audit for proper clerical coding of claims during the reporting month. Standard 9 - 45 second or less average speed of answer for all telephone inquiries received during the reporting - 5% or less call abandonment Comprehensive Health Insurance AssociationNumber of Claims ReceivedAugust 2016 - July 2017(as compared to Previous Year)

3 0100200300400500600700800 Aug-15 Aug-16 Sep-15 Sep-16 Oct-15 Oct-16 Nov-15 Nov-16 Dec-15 Dec-16 Jan-16 Jan-17 Feb-16 Feb-17 Mar-16 Mar-17 Apr-16 Apr-17 May-16 May-17 Jun-16 Jun-17 Jul-16 Jul-172 Alaska Comprehensive Health Insurance AssociationService Code Analysis*For the Month of July 2017 SubmittedPPO or Other Deductible Coinsurance Total Claim Code Description Charge Discount Ineligible Amounts Amounts Paid LinesANCILLARY CHARGES667, $ 48, $ 393, $ $ $ 224, $ 160 PART B CO-INSURANCE3,252, $ $ 3,212, $ -$ -$ 39, $ 318 CANCER $ $ -$ -$ -$ $ 1 CHIROPRACTIC2, $ -$ $ -$ $ 2, $ 22 DIAGNOSTIC TESTING23, $ 7, $ $ $ $ 14, $ 84ER $ -$ -$ $ -$ -$ $ $ -$ $ -$ -$ 2 EMERGENCY ROOM5, $ 2, $ -$ $ -$ 2, $ 2 HOME HEALTH $ $ -$ -$ -$ $ 3 HOME HEALTH , $ $ -$ -$ $ 1, $ 3 INTENSIVE CARE UNIT321, $ 26, $ 270, $ -$ $ 25, $ 2 INJECTIONS4, $ $ -$ -$ $ 4, $ 4 MISC CHARGES36, $ $ 6.

4 $ $ $ 29, $ 28M/N $ -$ $ -$ $ $ 3 OFFICE VISIT7, $ $ $ 1, $ $ 4, $ 27 PHYSICAL THERAPY2, $ $ $ $ -$ 1, $ 14 PRESCRIPTION DRUGS53, $ -$ -$ 2, $ 4, $ 47, $ 166 SURGERY11, $ 1, $ $ 2, $ $ 6, $ 11UB DIAG TESTING4, $ $ -$ $ $ 2, $ 17 TOTALS4,400, $ 88, $ 3,884, $ 10, $ 6, $ 409, $ 868* Represents claims adjudicated in the month.

5 May not tie to the financials depending on the timing of voids and Comprehensive Health Insurance AssociationService Code Analysis Year to DateJanuary - July 2017 SubmittedPPO or Other Deductible Coinsurance Total Claim Code Description Charge Discount Ineligible Amounts Amounts Paid LinesANCILLARY CHARGES4,017, $ 303, $ 1,913, $ 11, $ 14, $ 1,664, $ 1,149 AMBULANCE4, $ -$ 1, $ 1, $ $ 1, $ 8 ANESTHESIA11, $ 1, $ 1, $ -$ $ 7, $ 7 PART B CO-INSURANCE23,270, $ 2, $ 21,212, $ -$ -$ 336, $ 2,471 CANCER THERAPIES4, $ $ -$ $ $ 3, $ 7 CHIROPRACTIC16, $ 1, $ $ 1, $ 1, $ 12, $ 140 DIAGNOSTIC TESTING258, $ 27, $ 99, $ 15, $ 2, $ 112, $ 717ER PHYSICIAN14, $ 1, $ 3, $ 1, $ $ 8, $ 21 EQUIPMENT3, $ 1, $ -$ 1, $ $ 1, $ 19 EMERGENCY ROOM52, $ 9, $ -$ 1, $ 1, $ 40.

6 $ 49 HOME HEALTH CARE6, $ $ -$ $ $ 5, $ 19 HOME HEALTH , $ 6, $ -$ 1, $ 1, $ 17, $ 36 HOSPICE3, $ $ -$ -$ $ 2, $ 16 HOSPITAL INPT VISIT9, $ $ 2, $ 1, $ $ 5, $ 21 INTENSIVE CARE UNIT329, $ 27, $ 270, $ -$ 1, $ 30, $ 3 INJECTIONS55, $ 6, $ 6, $ 1, $ 1, $ 39, $ 46 IMMUNIZATIONS1, $ $ -$ -$ -$ 1, $ 15 MISC CHARGES536, $ 1, $ 482, $ 4, $ 1, $ 46, $ 170 MAMMOGRAM1, $ $ -$ $ $ 1, $ 10M/N OUTPATIENT4, $ $ $ 1, $ 1, $ 1, $ 18 MULTIPLE SURGERY5, $ $ $ $ -$ 3, $ 4 OFFICE VISIT49, $ 1, $ 7, $ 10, $ 1, $ 27, $ 186 PRIVATE ROOM17, $ $ -$ -$ 1, $ 15, $ 1 PHYSICAL THERAPY36, $ 7, $ $ 1, $ 1, $ 26, $ 121 PRESCRIPTION DRUGS370.

7 $ -$ -$ 63, $ 30, $ 276, $ 1,099 SURGERY95, $ 13, $ 37, $ 4, $ 2, $ 37, $ 85 SPEECH THERAPY3, $ 1, $ -$ -$ -$ 2, $ 8UB ANESTHESIA3, $ $ -$ -$ $ 2, $ 2 URGENT $ -$ $ -$ $ $ 2UB DIAG TESTING87, $ 11, $ -$ 9, $ 4, $ 63, $ 255UB SPEECH THERAPY8, $ $ -$ $ 1, $ 6, $ 24UB PHYSICAL THERAPY8, $ $ -$ -$ 1, $ 6, $ 44UB SURGERY33, $ 3, $ -$ 5, $ 2, $ 21, $ 9UB CANCER THERAPIES7, $ $ -$ 2, $ $ 4, $ 7UB RESP $ $ -$ -$ $ $ 2 WELLNESS EXAM3, $ $ -$ -$ -$ 2, $ 8 WELLNESS TESTING5, $ 1, $ -$ 1, $ -$ 1, $ 29 TOTALS29,365, $ 434, $ 24,038, $ 145, $ 76, $ 2,840, $ 6,8284 Alaska Comprehensive Health Insurance AssociationTop Provider Report For the Month of July 2017 RANKDESCRIPTION# OF CLAIMS SUBMITTED CHARGES PAID BY PLAN 1 RENAL CARE GROUP ALASKA INC 28 $ 903.

8 216, $ 2 PROVIDENCE HEALTH & SERVICE WASHINGTON18 $ 453, 46, $ 3 ANDRZEJ R MACIEWSKI MD 7 $ 28, 28, $ 4 DENALI DIALYSIS12 $ 1,111, 7, $ 5 GENEVA WOODS PHARMACY INC 7 $7, 5, $ 6 ALASKA EAR NOSE & THROAT 1 $5, 5, $ 7 SURGERY CENTER OF WASILLA 1 $4, 4, $ 8ST ELIAS SPECIALTY HOSPITAL 1 $ 101, 3, $ 9 FRESENIUS MEDICAL CARE SW ANCHORAGE4 $ 310, 3, $ 10 ALASKA SPINE INSTITUTE 5 $7, 3, $ 11 FRESENIUS MEDICAL CARE 5 $ 388, 2, $ 12 LIBERTY DIALYSIS ALASKA 3 $ 336, 2, $ 13 KETCHIKAN GENERAL HOSPITAL CLINICS9 $ 14, 2, $ 14 PAIN AND HEADACHE CENTER 6 $2, 1, $ 15A JOINT EFFORT PHYSICAL THERAPY6 $1, 1, $ 16 SPINE AND JOINT REHABILITATION10 $1, 1, $ 17 BOND PHARMACY INC 1 $1, 1, $ 18 MAT-SU SURGICAL ASSOCIATES APC1 $1, 1, $ 19 SWEDISH HEALTH SERVICES 2 $ 298, 1, $ 20 VIRGINIA MASON CLINIC 4 $ 26, 1, $ 21 DAVID D BUCKLAND2 $1, 1.

9 $ 22 DIALYSIS ASSOCIATES OF ALASKA 18 $ 29, 1, $ 23 FAIRBANKS MEMORIAL HOSPITAL 11 $ 17, 1, $ 24 IVY HOME INFUSIONS LLC 1 $1, 1, $ 25 REIFENSTEIN DIALYSIS CENTER 1 $ 69, $ 26 SWEDISH HEALTH SERVICES 11 $ 11, $ 27 ADL INC3 $- $ 28 ALASKA TELEMEDICINE CONSULTANT2 $ $ 29 WASILLA RENAL CARE GROUP LLC 1 $ 83, $ 30 MAYO CLINIC HOSPITAL-ROCHESTER1 $ 29, $ Top 30 Total1824,251, $ 351, $ 5 RANKDESCRIPTION# OF CLA