Health Decisions’s pioneering ‘Post Payment Administration’ system helps insurance companies cope with rising cost pressures
Health insurance companies can reduce risks and improve profitability by lowering actual claim costs utilizing a Post Payment Administration system offered by Health Decisions Inc. of Plymouth, Michigan
Plymouth, MI (PRWEB) October 1, 2004 -- Most health insurers have taken
traditional cost-containment efforts to the limit but generating the level of
savings needed in today’s highly competitive benefits marketplace remains a
challenge.
The best way to reduce risks and improve profitability is to
lower actual claim costs – and that is exactly what Health Decisions, Inc. of
Plymouth, MI, can do for health insurance companies. Health Decisions offers the
most comprehensive Post Payment Administration system in the
industry.
“Some insurers already have claim recovery efforts in place for
subrogation or other areas,” says Si Nahra, the firm’s founder and president.
“Health Decisions does not disrupt these existing relationships. We pursue only
those claims not already identified by existing recovery efforts, and typically
return an additional 1-3 percent of claims in recoveries.”
No system, no
matter how good, can compensate for the pressures for quick claim turnaround
that prevents full investigation of all claims prior to payment. Because Health
Decision’s review does not start until after a claim is paid it has the time to
look into the difficult to document details that lead to
recoveries.
Health Decisions goes much deeper seeking claims to recover
by conducting a review of 100 percent of claims in more than 30 areas to
identify and recover claims paid that is not the payor’s responsibility.
Health Decision’s approach to claims recovery works so well because
it:
* Combines existing data files from various sources
to identify cases that fit recovery profiles in dozens of areas from
Coordination of Benefits and subrogation to Medicare recoveries, divorce decree
enforcement, and provider payment verification.
* Delves
into the details of each case to find facts not known when the claim was paid.
Tools we use include special surveys, verification calls, and independent
documentation.
* Doesn’t stop until a claim is collected or
closed. Its collections do not involve individual enrollees. Instead, Health
Decisions focuses on other plans, providers, Medicare and judicial judgments to
get recoveries.
* Tracks and accounts for those recoveries
using Health Decisions’ automated credit tracker tool that can account for all
outstanding recoveries from any source.
“The insurer selects the level of
involvement desired from us,” says Nahra. “Or Health Decisions can train an
insurer’s staff to do recovery internally and license its Claim Recovery
Software Suite for the client’s use. For those clients with recovery efforts in
place, we coordinate with these efforts to avoid duplication.”
Because
Health Decisions is at the cutting edge of technology it helps insurers better
deal with:
* The fallout of automated adjudication of
claims
* Fraud and abuse detection and
prevention
* Medicare recovery
*
Identifying the best Continuous Quality Improvement (CQI)
solution
* Satisfying HIPPA and other regulatory
requirements
Health Decisions Post Payment Administration system for
payors includes emphasis on span of control, financial return, staffing,
implementation, and CQI. Its suite of services covers data handling, data
processing, case investigation, and case updates.
About Health
Decisions:
Health Decisions, Inc., a privately owned, Michigan Corporation,
specializes in benefit data management services to clients throughout the
country.
Since 1985, Health Decisions, Inc. has successfully served
hundreds of clients -- HMOs, insurers, TPAs and self-funded groups of all sizes.
The firm successfully processes annually more than a billion dollars of paid
claims data and processes special surveys for more than 225,000 covered
members.
Health Decisions has taken its core competencies of technical
expertise, data sophistication, and a pragmatic service orientation and
developed a series of products with proven value and considerable potential for
growth.
Health Decisions, Inc. distinguishes itself with its service
philosophy: Respect for existing procedures; emphasis on customization; and,
focus on solutions
For further information about Health Decisions Post
Payment Administration services for insurers go to www.healthdecisions.com,
send an inquiry to hdi@healthdecisions or call 800.589.2500.
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Source : http://www.prweb.com/releases/2004/10/prweb163045.htm