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Accumulator types

Updated on August 31, 2021

Financial accumulators

The Accumulator Manager tracks the following financial accumulators:

  • Individual deductibles
  • Family deductibles
  • Individual out-of-pocket maximums
  • Family out-of-pocket maximums
Benefit limit accumulators

The Accumulator Manager tracks the following benefit limit accumulators:

  • Number of visits
  • Units of service performed
  • Number of days

The Accumulator Manager accommodates accumulators matched to individual benefits and also the accrual of benefit utilization across multiple services; for example, a 30-visit limit per calendar year for any combined services in the following category: physical therapy, occupational therapy and/or speech therapy.

Authorization accumulators

Authorization accumulators are used to track the accrual of healthcare service utilization against pre-determined limits and targets and, like other types of accumulators, can be expressed in both financial and service utilization (visits, units, and so on) terms

The Accumulator Manager tracks the utilization of those services as they are reported during claims adjudication and can also be configured to further assist the plan in managing the care of these patients. For example, the Accumulator Manager is designed to communicate with the health plan clinical staff when the patient reaches a certain threshold prior to meeting or exceeding the authorized service target, thereby facilitating improved proactive clinical management and continuity of care.

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