By the Numbers

By the Numbers, 2006 statistics

  • Processed 2,638 claims, totaling $967,948 for the state’s Transplant Safety Net Program. 

VSHP is quick and accurate.

  • Handled just over 8 million claims. 
  • Nearly 99.6% of these were paid within 30 days. 
    • 100% were processed within 60 days.
    • Correctness rate: 99.61.
  • Answered 464,084 member phone calls.
    • Average speed of answer was 12.4 seconds.
  • Answered 333,205 provider phone calls.
  • Average speed of answer was 18.6 seconds.
  • Answered 153,163 requests for approval of medical services. 
  • Answered 78,622 provider calls. 
    • Average speed of answer was less than 30 seconds.
  • Handled 3,595 member appeals.

VSHP provides individual service.

  • Helped 10,255 members in setting up office visits with specialists.
    • Supplied care coordination services for 2,995 members with long-term diseases.  The Care Coordination Program offers counseling and education to members.
  • Supplied Emergency Services Management for 2,916 members who overuse the emergency room.
  • Helps the member move from crisis approach to stopping problems before they start.
  • Supplied disease management services for 33,771 members with diabetes, heart failure, asthma, or who were pregnant.  The reason for the programs is to teach the patients about their conditions.
  • Supplied case management services to 9,821 members. Our Case Management Program offers quality and cost-effective programs for members who need complex care.  It does this without causing pauses in services. 
  • Helped 1,087 members with planning.  We helped members get correct care when leaving the hospital.
  • Worked with the children in state custody. Helped 5,271 children to get quick access to benefits.
  • Answered 12,678 calls from caseworkers to bring together medical care, PCPs and other needs for children in state custody.

VSHP has large provider networks and watches care quality.

  • Kept networks of nearly 12,000 doctors, hospitals and other health care providers for our members.
  • Graded the quality and safety of services from network providers.
  • Made office visits and medical record reviews. Made reviews of network providers.
  • Supported quality of care and member safety by looking into member problems.
  • Worked to have out-of-network specialists for members’ care, when there were no suitable specialists in the network.
  • Supplied open communication meetings between providers and VSHP.
    • Made sure that medical and behavioral care work together. 

Our accreditation was received from NCQA.  Outcomes and member satisfaction are watched through NCQA, HEDIS, and CAHPS.

VSHP works to improve the health of members.

  • Called 553,115 members by phone. 
  • We made 6,537 appointments. 
  • We mailed 1,887,458 TENNderCare health materials to members. 
  • Offered education to primary care providers on TENNderCare requirements. We work to make sure the work is done completely.  And we work to make sure the billing is right.  We stress follow-ups for correct treatment.
  • Offered a health information library, with around-the-clock phone, for
    • 1,134 general health topics,
    • 248 women’s topics, and
    • 274 parenting topics. 
    • There are 620 Spanish topics.  
    • Members use this service an average of 1,150 times per month and 13,953 times per year.