Comparing Gold-standard Copayment and Coinsurance Values From Claims Processing Engines to Values Derived From Behavioral Health Claims Databases.

ABSTRACT:

Background

While researchers use patient expenditures in claims data to estimate insurance benefit features, little evidence exists to indicate whether the resulting measures are accurate.

Objective

To develop and test an algorithm for deriving copayment and coinsurance values from behavioral health claims data.

Subjects

Employer-sponsored insurance plans from 2011 to 2013 for a national managed behavioral health organization (MBHO).

Measures

Twelve benefit features, distinguishing between carve-in and carve-out, in-network and out-of-network, inpatient and outpatient, and copayment and coinsurance, were created. Measures drew from claims (claims-derived measures), and benefit feature data from a claims processing engine database (true measures).

Study desig

SUBMITTER: Friedman SA 

PROVIDER: S-EPMC8917070 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature