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HPMR saves NMI $16.7M in 4 years
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Posted on Aug 17 2005
The NMI Retirement Fund’s third party administrator for the group health insurance reported a $16.7 million savings realized over four years.
In a report to the Retirement Fund Tuesday, Hawaii Pacific Medical Referral said that it processed and paid health providers $50.6 million on behalf of the CNMI government from Sept. 1, 2001 to July 31, 2005.
For off-island claims, HPMR said that it saved $16 million and paid only $38.9 million or a net savings of 63 percent.
For on-island claims, HPMR realized a net savings of 8 percent or a discount of $790,000.
Total payment to on-island providers was $8.5 million.
Fund administrator Karl T. Reyes said HPMR processed and settled a total of $50.5 million out of the $68.9 million in total charges.
He said the remaining unpaid amount of $18.4 million includes $14 million for the Commonwealth Health Center, $1.1 million for other local providers, and $3.3 million for off-island claims.
Overall savings are realized by HPMR through ineligible charges (now totaling $15.9 million), HPMR discounts with providers, COB or coordination of benefits, and co-pay and co-insurer.
Ineligible charges include those availed of by people who are not group health plan members or services that are not covered by the plan. They also include duplicate or questionable charges.
COB refers to charges shouldered by co- providers such as Medicare, StayWell or Calvo Insurance while the co-pay or co-insurer charges are those paid for by members in their premiums.
