Health Insurance KPIs, Metrics & Benchmarks

Buy Health Plans KPI Benchmarking “Data-as-a-Service” Products from Opsdog

Opsdog.com sells Health Plans KPI and benchmarking data in three different ways.

1. Comprehensive Health Plans KPI benchmarking reports bundles that include 10 to 80+ measured KPIs.
   • Price range is from $750-$2000 per report
   • Instant download
2. Individual Health Plans KPI benchmarks that contain 1 benchmarked KPI –
   • Price range is $50-$65 per individual benchmarked KPI
   • Instant download
3. Custom Health Plans benchmarking KPI Data-as-a-Service projects and consulting engagements
   • 3-10 week long KPI benchmarking projects
   • Price varies based on scope
   • Hybrid on-site/off-site low-cost model

Browse Instant Download Health Plans KPI and Benchmarking Products for Purchase Below

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KPI's & Data

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Health Plan Members per Claims Employee

The total number of health plan members being served by the company divided by the number of employees working within the Claims Processing function over the same period of time.

KPI Type : Quality

KPI's & Data

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Number of In-Network Providers

The number of doctors, healthcare facilities or hospitals that are within the health insurance provider's network at a certain period of time. Includes both primary care (general practitione...

KPI Type : Quality

KPI's & Data

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Percentage of Claim Lines Paid $0 (Disclosed Edits)

The total number of claims that were filed, but for which the payer paid $0 due to disclosed claim edits divided by the total number of claims that were filed over the same period of time,...

KPI Type : Quality

KPI's & Data

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Percentage of Claim Lines Paid $0 (Undisclosed Edits)

The total number of claims that were filed, but for which the payer paid $0 due to undisclosed claim edits divided by the total number of claims that were filed over the same period of time,...

KPI Type : Quality

KPI's & Data

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Percentage of Claims Completed Within 16-30 Days

The number of medical insurance claims adjudicated within 16-30 days of receiving the claim from the healthcare provider divided by the total number of claims adjudicated by the payer over t...

KPI Type : Service

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KPI's & Data

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Percentage of Claims Completed Within 31-45 Days

The number of medical insurance claims adjudicated within 31-45 days of receiving the claim from the healthcare provider divided by the total number of claims adjudicated by the payer over t...

KPI Type : Service

KPI's & Data

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Percentage of Medical Claims Completed Within 46-60 Days

The total number of medical claims that are paid or transferred to patient responsibility (i.e., ?resolved?) within 46-60 business days following the initial claim submission divided by the...

KPI Type : Productivity

KPI's & Data

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Percentage of Claims Completed Within 60+ Days

The number of medical insurance claims adjudicated within 60 or more days of receiving the claim from the healthcare provider divided by the total number of claims adjudicated by the payer o...

KPI Type : Service

KPI's & Data

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Total Number of Health Plan Members

The total number of active health plan members, or policyholders, enrolled with the company at a certain point in time.

KPI Type : Volume

KPI's & Data

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Percentage of Patient Responsibility

The total amount of medical charges that the member, or policyholder, is responsible for divided by the maximum amount that the insurer will pay for a covered healthcare service, as a percen...

KPI Type : Service

KPI's & Data

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Percentage of EFT Users Still Receiving Checks

The percentage of in-network healthcare providers (e.g., physicians, hospitals, pharmacies, etc.) that have enabled/setup electric fund transfer (EFT) but are still receiving manually proces...

KPI Type : Service

KPI's & Data

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Percentage of Prescription Sales Covered by Medicaid

The number of prescription sales covered by Medicaid divided by the total number of prescription sales made over the same period of time, as a percentage.

KPI Type : Volume

KPI's & Data

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Percentage of Prescription Sales Covered by Medicare (Part D)

The number of prescription sales covered by Medicare Part D divided by the total number of prescription sales made over the same period of time, as a percentage.

KPI Type : Volume

KPI's & Data

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Average Handle Time by Call Reason: Application Inquiry

The average amount of time required to handle a customer call related to the status of their insurance application over a certain period of time, including after-call work (wrap time) and ho...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Benefits Inquiry

The average amount of time required to handle an incoming call from a customer inquiring about their health plan benefits over a certain period of time, including after-call work (wrap time)...

KPI Type : Productivity

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KPI's & Data

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Average Handle Time by Call Reason: Billing Inquiry

The average amount of time required to handle an incoming call from a customer inquiring about their bill(s) over a certain period of time, including after-call work (wrap time) and hold tim...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Broker Inquiry

The average amount of time required to handle an incoming call from an insurance broker selling the firm's health plan products over a certain period of time, including after-call work (wrap...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Claims

The average amount of time required to handle an incoming call from a customer inquiring about a health insurance claim over a certain period of time, including after-call work (wrap time) a...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Cost Estimate

The average amount of time required to handle an incoming call from a customer inquiring about cost estimates (out-of-pocket costs, etc.) over a certain period of time, including after-call...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Deductible Inquiry

The average amount of time required to handle an incoming call from a customer inquiring about their health insurance deductibles over a certain period of time, including after-call work (wr...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Default

The average amount of time required to handle an incoming call from a customer inquiring about past due medical bills or premium payments over a certain period of time, including after-call...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Eligibility Inquiry

The average amount of time required to handle an incoming call from a customer inquiring about their health plan coverage over a certain period of time, including after-call work (wrap time)...

KPI Type : Productivity

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KPI's & Data

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Average Handle Time by Call Reason: Issue Escalation

The average amount of time required to handle a customer call that requires an escalation, an issue which required "escalation" to a manager or supervisor, over a certain period of time, in...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Financial Assistance Program

The average amount of time required to handle an incoming call from a customer inquiring about the health plan financial assistance program eligibility and coverage over a certain period of...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: General Inquiry

The average amount of time required to handle an incoming call from a customer with a general inquiry over a certain period of time, including after-call work (wrap time) and hold time. Call...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: ID Card Inquiry

The average amount of time required to handle an incoming call from a customer inquiring about health plan membership ID cards over a certain period of time, including after-call work (wrap...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Medicaid

The average amount of time required to handle an incoming call from a customer inquiring about Medicaid coverage over a certain period of time, including after-call work (wrap time) and hold...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Medicare

The average amount of time required to handle an incoming call from a customer inquiring about Medicare coverage over a certain period of time, including after-call work (wrap time) and hold...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Not a Member

The average amount of time required to handle an incoming call from an individual that are not currently a health plan member, or customer, over a certain period of time, including after-cal...

KPI Type : Productivity

KPI's & Data

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Average Handle Time by Call Reason: Order ID Card

The average amount of time required to handle an incoming call from a customer inquiring about ordering new health plan membership ID cards over a certain period of time, including after-cal...

KPI Type : Productivity

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