ENROLLEEPROVIDER COMPLAINT MONTHLY REPORT NARRATIVE NOVEMBER 2007 by dtj80147

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									ENROLLEE/PROVIDER COMPLAINT MONTHLY REPORT NARRATIVE August 2009 Marta Stephens
                                                                                   TOTAL     % Against
                                                                                           Last Month
OVERALL MONTHLY COMPLAINTS/APPEALS VOLUME AND % AGAINST LAST MONTH                  125       -14%
ENROLLEE COMPLAINTS AND % AGAINST LAST MONTH                                         29       -36%
PROVIDER COMPLAINTS APPEALS AND % AGAINST LAST MONTH                                 90        -3%
“OTHER” COMPLAINTS APPEALS AND % AGAINST LAST MONTH                                  6        -25%

VALUE OPTIONS MONTHLY COMPLAINTS/APPEALS VOLUME AND % AGAINST LAST MONTH            97        -11%
ENROLLEE COMPLAINTS                                                                 12        -29%
PROVIDER COMPLAINTS                                                                 79         -7%
OTHER COMPLAINTS                                                                    6         -25%
VALUE OPTIONS RECEIVED 76% OF ALL COMPLAINTS, AND 38% OF ALL ENROLLEE
COMPLAINTS, 89% OF PROVIDER COMPLAINTS, 100% OF OTHER COMPLAINTS SINCE JULY 2009

NTBHA MONTHLY COMPLAINTS/APPEALS VOLUME AND % AGAINST LAST MONTH                    17        -19%
ENROLLEE COMPLAINTS                                                                 13        -35%
PROVIDER COMPLAINTS                                                                 4         +30%
OTHER COMPLAINTS                                                                    0         +0%
NTBHA RECEIVES 13% OF ALL COMPLAINTS, AND 44% OF ENROLLEE COMPLAINTS
AND 2% OF ALL PROVIDER COMPLAINTS AND 0% OF OTHER COMPLAINTS SINCE JULY 2009

STATE MONTHLY COMPLAINTS/APPEALS VOLUME AND % AGAINST LAST MONTH                    11        -31%
ENROLLEE COMPLAINTS                                                                 4         -55%
PROVIDER COMPLAINTS                                                                 7         +0%
OTHER COMPLAINTS                                                                    0         +0%
STATE RECEIVES 9% OF ALL COMPLAINTS, AND 17% OF ENROLLEE COMPLAINTS
AND 7% OF ALL PROVIDER COMPLAINTS AND 0% OF OTHER COMPLAINTS SINCE JULY 2009

ADVERSE DETERMINATIONS SINCE JULY 2009                                              358        N/A
ADVERSE DETERMINATIONS IN AUGUST 2009                                               219       +36%
38% OF ALL PROVIDERCOMPLAINTS INVOLVED 3 PROVIDERS DURING MONTH                     N/A        N/A
VALUE OPTIONS CALL VOLUME DURING AUGUST 2009                                       10846      +0%
ENROLLEE COMPLAINTS RESOLVED TO SATISFACTION DURING MONTH                            20       -33%
ENROLLEE COMPLAINTS RESOLVED TO SATISFACTION SINCE JULY 2009                         50        N/A
PROVIDER COMPLAINTS RESOLVED TO SATISFACTION DURING MONTH                            36       +30%
PROVIDER COMPLAINTS RESOLVED TO SATISFACTION SINCE JULY 2009                         61        N/A

								
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