Progress: Standard Calculation Definition (Proposed)​

$ Total Savings PMPM (all programs): The sum of dollars prevented, avoided or recovered as a result of PI Activity (FWA, Subrogation, COB, Pre and Post pay Data Mining and Clinical Validation programs). Savings is the variance between what you could have paid and what was paid inclusive of retroactive adjustments for overturn disputes and reprocessing for errors. Include 100% of all finalized /paid medical claims inclusive of claims that are capitated, delegated our excluded from one or more PI programs. ​

Divide this sum by # Members/Member Months: The count of all active members by month starting on the first of every month. Use sum of all members (member months) for an annual PMPM.​

• Reporting Period: By date of service based on lag time of 6 months after receipt of claim. If you’re calculating savings at the claim level, use FIRST date of service ​

• Pre-Pay Savings: Difference between what would have been allowed vs. what was actually allowed​

• Post-Pay Savings: Difference between original paid amount and the new paid amount ​

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