Claims oversight and management is so much more than just processing, auditing and paying claims. Claim oversight and management begins before the patient requires services. Our proprietary system, in conjunction with our Patient Advocate services we begin to manage and assist the member in finding the best care at the best price. We help to direct them to the Tier 1 providers and coordinated prior authorizations and medical management.
After the claim is incurred we carefully monitor the claims and follow-up with the members to provide alternatives and better pricing. We re-negotiate high-dollar claims. We monitor each member for potential high cost procedures and work to obtain better rates prior to the services as well as after the services are rendered.
Each group gets their own claims manager and provider relations person to ensure that the claims costs are monitored continuously. On average this process saves 10-15% on your claims above your existing PPO Network.