Always Looking Out for Clients
We know the difference between straightforward claims and those that require an extra level of scrutiny to find additional savings for our clients. Our experienced claims reviewers and strategic auto-adjudication usage contribute to additional savings of up to 15% for our clients, on average*, before network discounts. Here's how we do it.
High-Cost Services & DiagnosesSome claims require extra attention. When claims come in for high-cost services, we take a closer look for things like:
- Billing errors
- Negotiated savings opportunities
Waste & Abuse ProtectionWe utilize cutting-edge technology to analyze historical claims for questionable provider billing patterns. We also use experienced waste and abuse-fighting reviewers to determine that claim dollars are going to valid claims, not bogus ones, putting a stop to ongoing waste and rooting out past abuse.
Subrogation ReviewRecovering overpayments and other claims can bring big savings to a self-funded benefit plan. We scrutinize paid claims to find other parties that may be liable to pay for a specific claim, and we’ll work to help our clients recover any associated paid claims.
Hospital Bill AuditingOur auditing helps catch costly errors and miscalculations in complex hospital bills. Through special processes, we scrub itemized bills, review medical records, and identify any billing issues, and then we work with the facility to resolve any questionable charges.
Managing Costs With EdgeEdge is our complete cost management package, with comprehensive solutions that go above and beyond for our clients. By helping to make sure money is only spent where necessary and reducing waste, our clients see significant savings.
*Rolling three-year average, as of 12/31/2020.
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