Our High Impact program uses sophisticated predictive modeling and risk assessment programs to identify covered participants with the greatest potential for incurring significant claims. We then help customize their treatment and self-management plans to minimize future high-dollar claims.
We utilize a
Highly Automated
and Consistent Benefits Administration System, recognized as a leader in benefit administration technology.
The automation and
controls provided by our
Highly Automated and
Consistent Benefits Administration System has allowed us to shift resources to enhance claims turnaround, accuracy and overall customer service.
Our ClaimsWatch program has been designed to ensure that we are fair in our processing, but have the controls in place to eliminate inappropriate expense. This includes:
Fully-integrated clinical edits, billing and "flags" applied to providers, patients, treatments, diagnoses and any other area of concern
On-site clinical resources
Application of sophisticated post-processing surveillance software and fraud detection software, plus use of a Special Investigations Unit (SIU) to monitor activity.
Aggressive pursuit of savings on all claims submitted from non-contracted providers. We have gained an average discount of 23% on more than 50% of the claims we pursued for a discount.
Unique electronic connections with vendors and procedures that enhance controls around Medicare, integration, coordination of benefits and third-party liability.
All in all, these programs save our clients $0.48 - $0.55 of every $1.00 billed by health care providers.
