Insurers
Most insurers have taken traditional cost-containment efforts to the limit. But generating the level of savings needed in today’s highly competitive benefits marketplace remains a challenge.
The best way to reduce risks and improve profitability is to lower actual claim costs - and that is exactly what Health Decisions can do for insurers. Health Decisions offers the most comprehensive Post Payment Administration system in the industry.
Some insurers already have claim recovery efforts in place for subrogation or other areas. Health Decisions does not disrupt these existing relationships. We pursue only those claims not already identified by existing recovery efforts, which typically return 1-3 percent.
No system, no matter how good, can compensate for the pressures for quick claim turnaround that prevents full investigation of all claims prior to payment. Because our review does not start until after a claim is paid we have the time to look into the difficult to document details that lead to recoveries.
Health Decisions goes much deeper seeking claims to recover by conducting a review of 100 percent of claims in more than 25 areas to identify and recover claims paid that is not the payor’s responsibility.
Health Decision’s approach to claims recovery works so well because we:
- Combine existing data files from various sources to identify cases that fit recovery profiles in over a dozen areas from COB and subrogation to Medicare recoveries, divorce decree enforcement, and provider payment verification.
- Delve into the details of each case to find facts not known when the claim was paid. Tools we use include special surveys, verification calls, and independent documentation.
- Don’t stop until a claim is collected or closed. Our collections do not involve individual enrollees. Instead, we focus on other plans, providers, Medicare and judicial judgments to get recoveries.
- Track and account for those recoveries using Health Decisions’ automated credit tracker tool that can account for all outstanding recoveries from any source.
The insurer selects the level of involvement desired. It can be as simple as providing approvals to proceed that commence each of the three steps. Or Health Decisions can train your staff to do recovery internally and license our Claim Recovery Software Suite for your use. For those clients with recovery efforts in place, we will coordinate with these efforts and avoid any duplication.
Because Health Decisions is at the cutting edge of technology we can help insurers better deal with:
- The fallout of automated adjudication of claims
- fraud and abuse detection and prevention
- Medicare recovery
- identifying the best Continuous Quality Improvement (CQI) solution
- satisfying HIPPA and other regulatory requirements
Health Decisions Post Payment Administration system for payors includes emphasis on span of control, financial return, staffing, implementation, and CQI. Our suite of services covers data handling, data processing, case investigation, and case updates.