Comprehensive solutions for property and casualty healthcare payors
Added efficiency and cost-savings for Workersâ€™ Compensation and Auto Medical payorsÂ
Restore productivity for injured workers more quickly and cost effectively.
Get more value from your liability dollars â€“ for you and for your policyholders.
Ensuring healthcare network quality
We contract directly with over 99% of our network providers
We credential providers every three years using nationally recognized accreditation standards, and monitor for quality continuously
Most providers offer discounts below state fee schedules
Our comprehensive data quality program uses data mining, self-service portal tools, and an outbound call center staffed by full-time ±«ÏÊÄ¤ÊÓÆµ employees
Enhance your bill review with advanced payment integrity
Your bill review program canâ€™t be beat when it comes to applying juris rules and standard edits. You may even incorporate nurse reviews. But provider billing grows more complex every day. ±«ÏÊÄ¤ÊÓÆµâ€™s Payment Integrity services combine automation with clinical review by a board certified physician, certified coder or licensed nurse so that we can target costly, hard-to-catch issues like contradictory or overlapping services, unlikely service combinations and suspect billing patterns.
We fit seamlessly into your bill review process to help you address billing waste and abuse, and deliver an additional 1% to 2% reduction in medical spend.
Containing out-of-network medical spend
Bill repricing with Data iSight
Defensible, highly accepted pricing methodology for bills with no established fee schedule
Reach agreement using ±«ÏÊÄ¤ÊÓÆµ negotiation services
Our 450 negotiators and support staff use sophisticated technology and financial benchmarks to drive success
Improve competitiveness and reduce medical spend. Use ±«ÏÊÄ¤ÊÓÆµ’s payment integrity and cost management services to enhance the value of your property and casualty bill review and managed care program.