Enhanced Claims Control

A Fine Tooth Comb for Savings

When it comes to keeping costs low, our Enhanced Claims Control (ECC) solution closes gaps and helps ensure our clients’ money is being spent where it should be. This comprehensive set of services and tools is designed to reduce costs throughout all aspects of a client’s plan.

Our ECC solution is so effective that our clients see up to 60%* savings on their out-of-network claims.

Explore ECC's services and tools designed to help reduce costs:

Critical Claims Unit 

Trustmark Health Benefits’ Critical Claims Unit (CCU) uses a variety of approaches to help mitigate risk for claims that often have a propensity for billing errors, waste, abuse and to drive savings by creating opportunities to negotiate savings and better payment rates.

Hospital Bill Auditing

We have special processes to scrub itemized bills, review doctors’ orders and identify any billing issues. We then work with the facility to help resolve any questionable charges so clients aren’t stuck overpaying.

Learn more about our hospital bill auditing by downloading this deep dive flyer:

Learn more

Dialysis Cost Management 

Dialysis care can be costly and long-term. We provide specialized claim review, care management and support, and discount negotiation for the course of treatment.

Medical Specialty Drug Management 

Powered by Archimedes, LLC, we provide employers with a complete specialty drug management solution backed by near real-time data that addresses total medical specialty drug spend, regardless of benefit design or configuration.

More more about our medical specialty drug management.

Out-of-Network Discounts and Fee Negotiation

Discounted healthcare doesn’t have to be limited to in-network providers. If members visit an out-of-network provider, we provide a multi-tiered hierarchy of programs designed to take advantage of contracted discounts, cost-based reimbursement determinations, or negotiations.

Fraud Services 

With the industry experts at Covent Bridge, we use the latest in comprehensive investigative technology to mitigate risk for claims with a propensity for fraud, providing our clients with peace of mind and driving savings.

Subrogation Review

Our team performs an in-depth review of paid claims and screens for other liable parties, and if we discover another at-fault party, we’ll work to help our clients recover any associated paid claims.

Waste and Abuse Protection

We bring sophisticated technology similar to what’s used to monitor credit card purchase patterns to analyze historical claims for questionable provider billing patterns. We also use experienced waste and abuse-fighting experts to ensure claim dollars are being spent on valid claims, not bogus or padded ones.

Services We Review

Our Enhanced Claims Control solution finds savings by reviewing billing itemization, medical records, physician notes/orders, lab/radiology reports, patient notes, and Rx and IV administration details for the following types of services:

Transplants

Specialty Drugs

Chemotherapy Drugs & Radiation

Pain Management

Spinal Surgeries

Unlisted Codes

Drug Testing

Bone Growth Stimulators

Dialysis

Experimental & Investigational

Large High-dollar Claims   

To learn more about our Enhanced Claims Control solution, complete the form below: