this is... and could you only, you took 220 out of whatever, the universe of claims are. >> again, we are waiting for the reporting from uhc. regarding the impact of the claims. however claims it did impact. >> okay but there sno way to give usen estimate. >> you did a sample and if you were to apply the sample to the over all universe? >> right. so, we do not extrapolate out to say that because you had this number of errors in the sample, that means that it is exactly the same in the universe, but we do work one on one with uhc, to quantify the over all financial impacts, to the universe of those systemic issues that we identified. and they run reports, and

provide us with information to determine what is the over all impact. and are the over payments or under payments? and so that is just... >> why don't you apply it? >> we don't believe in extrapolating out to say, because we had a $5 error here that means that it is $5 million dollar error in the universe. >> why not? >> so it is just our they have done an analysis and determined that is not the process that we utilize and but we do work one on one... we do work one on one with the administrators to determine, the over all impact. and in the universe. so it does not mean that we stop at the sample, we work closely with them to determine, how many claims are affected. >> other questions, from commissioners? >> so, you know, sample of the claims, what percentage of that in the total universe? >> it is, we use an error of

driven formula, to select our sample. and it is not a, we are not taking a percentage of over all universe of claims. >> understood, but what percentage of that 220, is two percent of the total universe, five percent? 20 in >> no, it is not. it is much, it is a much smaller amount than that. so... >> so. >> it would be. >> one percent? >> less than one percent over all. >> okay. >> in the universe. within a whole year's worth of claims. >> okay. >> you are not talking about extrapolation, but if is one percent, and within the 220, if you found, five percent error rate, likelihood that out of that 99 percent, you might have also... >> so, our results are weighted based on the over all universe of claims. >> understood. >> and so, that the statistical accuracy is weighted based on the over all universe of claims. and so it is not a, like a pure

random calculation based on the 220 claims. we have a formula that we use that so many claims in the universe for each bucket and your accuracy is weighted to the universe, but we don't extrapolate dollars, we do not say that because we had 2,792 in the sample, because, we only ad uted less than one percent of the claims that is multiplied out.

and you need to be doing a better job, in over all claims payments. and that will be the advocacy that will represent here on the board and i will recognize that

it will not necessarily give you great comfort as a stastician but we need to translate to a policy understanding as we interact with the vendor. >> understood. >> okay. >> so, 100 percent behind you, thank you very much. >> and what i would suggest, because what i hear you saying is, because you have actually asked uhc to run what is the effective this, and the next time that you do this, don't present the audit without those findings, because you will go through this again. >> because really we are sitting here saying and with the commissioner asked the first time, how big is this? and right now, you can't tell us. >> exactly. >> you need to have the impact report. >> right. >> and that will be helpful. >> yeah, and i know that the tendency will be to drowned us and you will have all of these qualifying statements that you try to provide something of a layman's summary. if you can. and then i know that it is hard, statistically sometimes,

right? >> okay, thank you. >> thank you. >> so, the claims audit, we asked that information on the targeted claims, and the ten high dollar and the ten srd claims. so we find the two in-sample error and four out of sample errors on the targeted claims and now it should be noted that the targeted claims are not included in the statistical results of the audit, they are presented separately and the largest of the errors which uhd did agree to and under payment, in the amount of 208,080, what happened was that the claim that was manually denied by a process or in correctly. and now it should be noted that uhc did correct this error prior to our audit, and feedback was provided to the

processor, and regarding the filing the correct process and the guidelines. >> could i just jump in, i am a freak for details, do you know exactly what process they did not follow to make a $200,000 error? is there like i clicked the wrong button? or i mean, what exactly happened? >> so what the error resulted around and we have an in-patient stay where the member had precertificated for that stay. the processor did not read the notes within the file and denied the claim, requesting for medical records, where uhc had already approved the stay, the processor did not follow the correct guidelines in looking through the file to determine that the claim had already been reviewed. so that is where the under payment came from. >> and was that person fired?

>> okay. >> there is also, one additional under payment. and at the bottom, and of the notes and for 86,481.25 dollars, and when uhc did respond to our report, uhc did provide additional information regarding this error and that there will be removed from the list of errors. and uhc did provide the justification for the denial of this claim. >> so in addition to conducting a statistical audit as well as a two targeted audits, another come poeb component that we do is an administrational assessment. and it is a way to get a better understanding of the over all level of the claimed customer service that your members are

receiving. and we go in and we essentially kick the tires, and insure that the services sound and look for ways for the administrator to provide and enhance level of service going forward. and where they fall short, as well as best practices, that they may be needing. so, we reviewed uhc, and four key areas facility and organization and staffing, and claims and administration, and customer service, as well as audit programs. and we provided them with an analysis and determined that they were in a satisfaction range, with two bs and two cs. and so, certainly there are areas for improvement, but, they are in the middle of the pack and it is like the bell curve the way that assign a grade and most are in the middle and a couple at the top and a couple at the bottom and

uhc tends to generally follow in the middle range. and a couple of key contributers, to the fee, and the facility environment and staffing, very high level of turnover, attrition, statistics being reported for the claims and the customer service staff, much higher than we typically see and so you are going to experience the turnover and they have to bring in the new people and provide them with training. and the tenure from a claim's perspective, the claim process ors have a satisfaction level of tenure, but we felt like the customer service or health advisor, tenure, was light, quite a large percentage of your assigned representatives, have less than two years of experience, from a staffing level, perspective, the number of staff assigned, it seems to be appropriate, because they are generally meeting your claim turn around time and your

telephone responsiveness, objectives and, from a looking at the over all service facility, we think that the chico service center is quite stable. and not a lot of growth, basically extremely modest at one percent decline. and on the next category, the claim administration, very, very high level of claims, on your calendar, are received electronically and so, with less coming in by paper, there is less human error of keying of the claims, we could not

obtain the statistics, to form a statistics, and from those vendors, and so, that is, we hope that uhc reconsiders the position there going forward. so that there is full discloser on the inventory control performance and, we looked at auto adjudication rates and what percentage are automatically processed by the system rather than requiring the review manually by a processor and a high level of rate there. positive things here, is... >> could you just give us the highlights. >> sure. >> a couple of other highlights, just over all, handling over the payment, and recovery, coordination of the benefits and activities and are in line with what we typically see in the industry, and so a

solid b in this category. and the customer service, and your hours of operation in line with what we typically see for other clients, participants, and we wish that they offered secure messaging to the members and that is where they fall down a little bit and we looked at the first call resolution and performance and the struggle to resolve the calls on the first contact and a couple of other highlights, resolving open issues and right now there are no reports to show, how quickly uhc is able to close open issues, on your account, and so, that

contributed to the fee. s the audit programs, a solid b, the level of review done by the management is in line with what we see when they are looking at the claim quality of the individual process or. and the high dollar audits using a 10,000 dollar threshold for a second level of set of eyes review and that is in line with what we see in the industry, generally they are meeting your contract objectives for accuracy and turn around time and only the area of improvement, i think is maybe to increase level of the call audits but still, there is still a very solid b. and so, if we were to blend this score, over all, i would say, that they are closer to a b than a c. >> uhc will be providing a

corrective action plan? >> correct, we are working with uhc, they did provide additional information, for some of the auditors and so we will review, each of the errors that uhc disagrees with, and we will ask uhc to provide an updated action plan, based upon the newer ors. >> i would like to asked the other commissioners, this kind of a grade we would like them to present to us not just a written response to the staff. >> i agree. >> why they don't offer it, what customer service on earth does not have access to secure messaging? >> and they own a company, optum that does way more than secure messaging, and that i used to advice for, and so, the capabilities are there, just not turned on.

>> the call back capability reporting, what exactly is this. >> this is a wish list item, and we would love for the administrators to have it. if a member calls in and the issue is not resolved right then and there is say that it is a claim that needs to be adjusted and they say that i don't want you telling me that it is adjusted in ten days, but i want you to call me to tell me that it has been adjusted i don't want to assume that it is done, i want that confirmation and they asked for, a commitment from them to give them a call. and being able to track the keeping of the commitment from the member, if you tell them that you will call them on a certain day, did you really do it or not? and most administrators do not have the external reporting capabilities to show if they are keeping the commitment with the member and there is a lot

of noise generated by unhappy members that don't get a call back. >> and so we want the reporting to be provided and there is only two that can do it and it is only for the select clients and we want uhc to do it but today they are not able to do provide those to clients. >> it is complicated for the members who have medicare, and i try to track the bills, and because the time being and you don't know when you hit your $250, and you have it, and just to track that is not simple. and the cross over just disappeared in mine for one reason or another, and i am not saying that this is their fault, and you try to call the medicare and see what, you know, for a member to get it involved in this is really not

easy. and they tell you to call uhc and they say that it is medicare's fault and so it is complicated. any other comments or questions by commissioners? >> you don't need to do the request, you are right next to me. >> yes, i am trying to turn my mic on. >> when do you expect this follow up action plan to be completed? >> if they are working on it, i understand it. and so, is this within, the next month or two? next year? >> we will ask, and the uhc to respond within three weeks, we typically give each administrator three weeks to respond to each error report, because of the of the amount of reporting that they needed to provide, it was unavailable at

the time, but we will give them three more weeks. >> if we were to follow the suggestion of the president, and president fray sure, and assume thating we take an action, this afternoon, that we probably will, based on the fact that commissioner shlain is here and we will have our hides if we don't, november will be the earliest that they can come before the group and present this information,; is that correct?? >> correct. >> okay. >> they will not be ready by september? a month away? >> september? >> i am sorry. september,... >> so we will be ready >> september? >> we will aim for the september. >> okay. >> and did you want to convey that to him? >> president? >> i think that we have done that. >> okay. >> i think that uhc, is yeah, yep. >> you are here. >> okay, thank you. >> and so the public comment, at this point. >> sure. >> with united healthcare and i am not a part of the audit team and we do have a specific audit

team that works with aon and bring me in on the findings and so we did all go over the responses and i know that they are working on the reporting and things and i guess that my own thought will be that we have not met with the hsf and we have disagreed and provided them more feedback and we removed one error and so the results that you are seeing have not been finalized and we do that and we know what the true response is and what does have to be followed up and i don't know if that could be accomplished considering that we are in the middle of august in time for a september board meeting and we could certainly keep in touch and look at those, but to your point, if there is no october meeting it will be move before the final, final will be done and it is just a timing matter. and you know, i can certainly, connect with our audit team and find out. >> that would be good. obviously, they are guide interested. >> absolutely agree. >> agree. >> thank you. >> any other public comment? >> all right, seeing none, this

is not an action item and we are not approving at this point. >> why don't we take a i am sorry, under estimated, how long this will take, and i note that we have different times as everyone noticed that? and the problem is that the public can't see that. and so using this one, let us be back at 2:40. >> next item please. >> item 7, approval of wellness plan, director dodd. >> the wellness report? >> so you have seen this before.

and i know that stephanie worked with president frasier on her concerns on it. and so we want to bring it back to you for final approval and it has been presented in final draft form and the mayor's office and the department heads but it is not, we will put it out widely once it is finally approved by the health service board, are there any other questions for stephanie? >> i just would like to say thank you very much for incorporating the comments that i suggested and i think that it makes it a stronger document, and it was already a strong document and with that i will move approval. >> second. >> any public comment? >> we will call the question, i am sorry. >> rebecca ryan from the

municipal association, and i just want to take a moment to echo my colleague bob, and we are extremely excited about the launch of the wellness program, and we are committed to working towards sustain able funding, and long term metric driven, analysis, and ultimately our goal, of course, is to link, wellness to healthcare costs. we leave that it is righteous and morally correct to care about people's health and the people that we represent, but we also believe that healthier people, should have an impact on the cost of their healthcare. and so, we see this as completely aligned with the work that we have done and. again to speak on another topic, but a related topic and i too want to express my appreciation for the tremendous effort that it took to insure

that the rates were not only were stabilized but actually reduced, and that is unprecedented in my, almost, eight years here and in my over 30 years in work in the labor movement, and the rates, simply do not go down, in my experience. so i think that people don't understand the incredible accomplishment that represents and i hope that we will continue that work, continue the work on accountability, and transparency, which i also believe is integral to managing healthcare costs and i hope that you will know that the municipal executive association and all of the labor groups in the city are your allies in this regard. and on this initiative. and we stand ready to help in whatever way that we can. >> thank you so much. >> thank you for the comments and recognizing the staff as

well and the commissioner who participated in that process. >> now, any other public comment? >> all right, we will call the question. all of those in favor? >> signify by saying aye. >> aye. >> all of those opposed? thank you. >> next item? >> item 8, action item, approval of the health service system membership rules, updates lisa ghotbi. good afternoon, chief operating officers, we just have a few rule changes proposed for the 2015 plan year, we are anticipating a few others, but those were related to the care act that actually were delayed and so they will be seen by the board next year for 16. and the first one that we will be talking about is regarding the healthcare fsa, care are forward and you may remember in january of this year, we amended the 14 plan year,

rules, to incorporate the new provision announced by the irs to allow for the carry forward of up to $500 on the healthcare, and since that time, we have had more clarification on what was allowed in terms of managing that carry forward and so these changes incorporate, some changes to the 500 and i wanted to just point to page 14 and just kind of review those, and so, what it allows us to do then is to say that carry forward balance of between, of a minimum of $10 and a maximum of $500. and we had carry forward balances of two cents, you know, it costs more to administer monthly than it was benefiting, and so, we would like to put in place a minimum and the carry forward is for one year and so the member has one additional member to use

that $500 after which it will be forfeited and we believe that this is the best marriage of the benefits to the member with the administrative issues that this represents. so, if you have any questions on that? >> you do not say if it is less than $10, because the members will be asking, that i have $9 in there and you are saying, that it is forfeited. >> and so, it is no language in there, that says that... >> and we do have that language, and so what you are saying is that we say after a year it is forfeited but we don't talk about the fact that there is forfeit turf unused funds at the end of the year on fsa and i think that it was about the balance of the rules and not describing the plan design and so we do have that language in the cafeteria document and in the other

documents about the fsa benefit, but the rules, language and what we have an appeal, we often refer to the rules, and to administer that and if we need to put that in we can, but usually we take the plan benefit information and put it in either the cafeteria plan or the other document and so the benefit guide, for example has an extensive amount of information on the part of the fsa benefit. >> so it is really up to the board if you want to add it to the rules we can, but there is that balance, of benefit design, detail in the rules, verses elsewhere. >> so i think that the commissioner lim what you are saying is that someone or a member were to read this, they would wonder what happens to the $10? >> yeah. >> because, i mean, you might put it in some other, i mean communications, but it is back to it and it does not say that.

>> on page 15, is that where you are reading? >> yeah. >> so, when it says, for one plan year after which any remaining care of funds will be forfeited. >> that is after it is carried forward. that is when after one year, and i mean, that it is over for the over funds will be forfeited. but not for the one that is... so... >> not the existing. >> not for the existing one. but... for example, you say for the 2014, i have $9.95 in there. and it is not going to be carried forward. and the members say that okay, could you give it back to me? it does not say that it is forfeited in here. so... >> right, so, we do have a whole section in our cafeteria plan, document which is on, you know, starts