Each Piece Has Its Place
Healthcare & Pharmacy Claim Review & Recovery Solutions
The case for healthcare & pharmaceutical claim review: the United States spends over $3.3 trillion annually on healthcare. The National Health Care Anti-Fraud Association (NHCAA) estimates that 3% or $99 billion of all healthcare spending is improperly paid due to fraud. In addition, the American Medical Association has reported that 19.3% of all healthcare claims are not paid according to contract. Healthcare claim review and recovery services help your organization to pay accurately the first time. As a result, your cash flow is better managed.
The Centers for Medicare & Medicaid Services report that 11% of their annual $1.2 trillion spends is paid improperly.
Given the magnitude of these statistics, the waste is staggering and ClaimInformatics can assist you in identifying and recovering your share while developing corrective action plans for your organization.
Medical care providers are experts at what they do, but they face an extremely complex payment system. When it comes time for them to invoice, providers make mistakes while navigating the cumbersome medical billing and coding landscape. Typical pharmacy contracts lack transparency, resulting in error-prone, complex pricing models.
The results: improper payments.
Free Identification of Errors ClaimInformatics sorts through the complexities, uncovers the errors and processes improper payments for reimbursement. A complete forensic review of 100% of your transactions will be conducted to re-adjudicate and identify improperly paid claims. We’ll submit claims for reimbursement. Since we understand what healthcare providers are looking for, our requests for reimbursement are less likely to be challenged.
Our Safe Harbor program offers fiduciary oversight by helping deliver protection and excellence in plan oversight through independent governance and monitoring. This Safe Harbor program avoids conflicts of interest and benefits both members and the plan while mitigating employer fiduciary and personal risk and offering access to critical fiduciary oversight.
The Safe Harbor program adds another layer of plan administration services and creates additional accountability and transparency that is especially appreciated during renewal periods. We can’t stress enough the great value and peace of mind from mitigated risk.
The plan has a two-tiered pricing model with identification and reporting based on a per member per month fee and recovery and reconciliation on a percentage of recovery or alternative additional per member per month fee.