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Revenue Integrity ĤƵ

Restore and protect premium dollars for your health plan

A Payment Integrity partner you can count on

“The things we value most about our partnership with ĤƵ is not just the reliable, efficient delivery of savings through their MSP and ESRD services, but the fact that they are always willing to come to the table to discuss and collaborate on new and innovative solutions that nobody else in the industry has yet to try."
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– Drew Satriano, VP of Payment Integrity at Highmark Inc
"Partnering with ĤƵ for their MSP and ESRD premium services was one of the easiest PI programs to stand up. The project returned significant value that was being lost due to other Plans changing our members’ status or from being unable to get a member labeled as ESRD. Those factors previously resulted in degradation to our CMS premiums and the project ultimately led to being able to identify gaps in our processes that we were able to shore up.”
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– Drew Satriano, VP of Payment Integrity at Highmark Inc
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Add millions to your bottom line

A key factor in successfully managing Medicare Advantage plans is ensuring you receive accurate premium payments from the Centers for Medicare and Medicaid ĤƵ (CMS). However, ongoing inaccuracies with member eligibility information and disease status markers mean that many health plans don’t get the dollars they’re owed.

As your healthcare revenue integrity partner, ĤƵ can help you restore and protect the premiums your health plan deserves. Whether optimizing Medicare Advantage revenue or proactively managing disease statuses, we ease the administrative burden of finding errors and making corrections—improving your efficiency and productivity and ultimately restoring millions of additional premium dollars for your health plan.

Get the entire premium you’re owed

ĤƵ’s Revenue Integrity services, Medicare Secondary Payer Validation (MSP) and End Stage Renal Disease Validation (ESRD), ensure Medicare Advantage plans receive the entire premiums they’re owed from Medicare by restoring any underpaid premium and correcting the root cause of the underpayment. Here’s how we do it.

The latest in Revenue Integrity

eBook

Restoring millions for your Medicare Advantage plan

Correctly paid Medicare Advantage premiums are a critical source of revenue for many health plans. Incorrectly paid premiums can result in millions of dollars in lost revenue. Download our eBook to find out how you can take charge of your premium revenue.

Ways we help

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Data analytics

Unlock the hidden value in your data and collect the full value of premiums owed to you for managing Medicare Advantage members

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Expert process

Achieve clarity, consistency, and improved results with best practices and highly skilled staff to guide you through every step of the premium restoration process

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Improved efficiencies

Reduce the time spent identifying root causes and recovering healthcare claims with ongoing support to ensure you continue to receive correct premiums

Our Revenue Integrity solutions

Medicare Secondary Payer (MSP) Validation

Could millions of dollars be hiding in your Medicare Secondary Payer (MSP) validation process? On average, 4% of Medicare Advantage members have open MSP records and 50% of those records have premium restoration potential. Our Medicare Secondary Payer Validation and Premium Restoration solution quickly and accurately validates MSP records, corrects inaccuracies, and restores millions in underpaid premium dollars.

How does it work?
Using a proprietary, HIPPA-compliant MSP software tool, we help health plans identify member records that require additional investigation, improved documentation, and submit transactions to Centers for Medicare and Medicaid ĤƵ (CMS) on your behalf

Who is it for?
Payment integrity directors and managers, and health plan analysts for Medicare Advantage plans

What does it do?
Restores MSP premiums by resolving member primacy errors and quickly ensuring validation and reconciliation

End-Stage Renal Disease (ESRD) Premium Restoration

Members with End-Stage Renal Disease (ESRD) account for a disproportionate amount of medical expenses. Without a plan to identify these members, your Medicare Advantage plan could be missing out on millions in additional premium dollars CMS should be paying for your members with ESRD. Our ESRD Premium Restoration solution helps identify members with missing ESRD statuses and restores millions in underpaid ESRD premiums.

How does it work?
With data analytics and partnerships with CMS and reporting entities, we ensure accurate member data and documentation to recover premiums not received for ESRD members

Who is it for?
Payment integrity directors and managers, and health plan analysts for Medicare Advantage plans

What does it do?
Delivers measurable premium restoration results by combining the best in identification analytics, business processes, and a client focus with complete transparency

Part D OHI Validation

To minimize risk and achieve revenue integrity, Part D plans must identify instances of other health insurance (OHI) among Part D members. Our Part D OHI Validation solution can help your plan pinpoint instances of other health coverage and ensure that data reported to CMS is accurate, valid, timely, and reliable.

How does it work?
Applies data mining and analytics expertise in order to optimize data validation and correct information to delivery updated eligibility information

Who is it for?
Payment Integrity directors and managers, pharmacy managers, and health plan analysts for Part D plans

What does it do?
Works in partnership with health plans’ in-house teams to update accurate eligibility information, which will help ensure future claims are paid appropriately

Medicare Advantage plans leverage ĤƵ’s expertise in revenue integrity to supplement their internal premium reconciliation efforts.

Why ĤƵ as your Revenue Integrity partner?

Recover and restore value to get the revenue you deserve and make healthcare more affordable.

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Proprietary analytics and data modeling

help identify members with the greatest propensity for inaccuracy and premium restoration potential

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Close monitoring of membership and CMS data

offers visibility into premium restorations and the CMS submission and acceptance process

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Our positive relationship with CMS

helps resolve errors and inaccuracies quickly and painlessly using their tools and processes

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A complete electronic
audit trail

of every completed validation and restored premium simplifies compliance and record tracking

Contact us today for more information on accelerating your Revenue Integrity efforts.