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TABLE 9C: MANAGED CARE ENROLLMENT/UTILIZATION
State Summary for North Carolina for 2007
27 Grantees
| Payor Category |
Medicaid
(a) |
Medicare
(b) |
Other
Public Including non-Medicaid CHIP(c)
|
Private
(d) |
Total
(d) |
| Revenue |
| 1a. Capitation revenue for Services |
0 |
0 |
0 |
0 |
0 |
| 1b. Fee-for-Service revenue for Services |
0 |
86,686 |
0 |
377,219 |
463,905 |
| 1. Total revenue for Services (Lines
1a + 1b) |
0 |
86,686 |
0 |
377,219 |
463,905 |
| 3a. Collections from Medicaid or Medicare
reconciliation/wrap around (for current
Year) |
0 |
0 |
|
|
0 |
| 3b. Collections from Medicaid or Medicare
reconciliation/wrap around (for prior
years) |
0 |
0 |
|
|
0 |
| 3c. Collections from patient co-payments
and from managed care plans for other
retroactive payments/ risk pool/ incentive/
withhold |
0 |
0 |
0 |
0 |
0 |
| 3d. Penalties or paybacks to managed
care plans |
0 |
0 |
0 |
0 |
0 |
4. Total Managed Care Revenue
(Line 1 + 3a + 3b + 3c) - (Line 3d) |
0 |
86,686 |
0 |
377,219 |
463,905 |
| Expenses |
| 5a. Capitation expenses for Services |
0 |
0 |
0 |
0 |
0 |
| 5b. Fee-for-Service expenses for Services |
0 |
86,640 |
0 |
400,000 |
486,640 |
5. Total expenses for Services
(Lines 5a + 5b) |
0 |
86,640 |
0 |
400,000 |
486,640 |
7. Total Managed Care Expenses
(Line 5) |
0 |
86,640 |
0 |
400,000 |
486,640 |
Surplus / Deficit
(Line 4 - Line 7) |
0 |
46 |
0 |
-22,781 |
-22,735 |
Surplus / Deficit as Percent of Expenses
(L4 - L7)/L7 |
--- |
0.1% |
--- |
- 5.7% |
- 4.7% |
| Utilization Data |
| 8a. Member months for managed care (capitated) |
0 |
0 |
0 |
0 |
0 |
| 8b. Member months for managed care (fee-for-service) |
0 |
4,332 |
0 |
37,872 |
42,204 |
8. Total Member months for managed care
(Lines 8a + 8b) |
0 |
4,332 |
0 |
37,872 |
42,204 |
| 9a. Managed Care Encounters (capitated) |
0 |
0 |
0 |
0 |
0 |
| 9b. Managed Care Encounters (fee-for-service) |
0 |
1,083 |
0 |
6,964 |
8,047 |
9. Total Managed Care Encounters
(Lines 9a + 9b) |
0 |
1,083 |
0 |
6,964 |
8,047 |
| 10a. Enrollees in Managed Care Plans
(capitated) (as of 12/31) |
0 |
0 |
0 |
0 |
0 |
| 10b. Enrollees in Managed Care Plans
(fee-for-service) (as of 12/31) |
0 |
361 |
0 |
3,156 |
3,517 |
10. Total Managed Care Enrollees
(Lines 10a + 10b) (as of 12/31) |
0 |
361 |
0 |
3,156 |
3,517 |
| 11. Enrollees in Primary Care Case Management
Programs (PCCM) |
53,620 |
0 |
344 |
0 |
53,964 |
| 12. Number of Managed Care Contracts |
0 |
2 |
0 |
4 |
6 |
data as of: 7/22/2008 3:38:34
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