Unscrambling The Egg, Health Decisions Inc. Recovers Money After Health Insurance Claims Are Paid
Giant health care insurers and mid-size to large corporations can improve profits by recovering money after health insurance claims are paid. Health Decisions Inc. a national leader in group health claim recovery, serves commercial insurers, HMOs, self-funded companies, consultants, brokers, union trusts, and government entities.
Plymouth, MI (PRWEB) October 6, 2004 -- A Plymouth company has positioned
itself at technology's edge so it can assist giant health care insurers and
mid-size to large corporations improve profits by recovering money after health
insurance claims are paid.
Health Decisions, Inc. has the power to review
claims already paid and find enough income in unpaid claims to produce up to a
10-1 return for clients.
"Our company is a pioneer as we are the first
and only one involved in Post-Payment Administration," explains Si Nahra, PhD,
President of Health Decisions, Inc. of Plymouth. "After everyone else is
finished, we apply our expertise, methodology and powerful software tools and
dig even deeper to uncover more money for self-insured employers and health
insurance companies."
Post-Payment Administration, akin to unscrambling
the egg, finds money to recover after health claims have been paid by insurance
companies or self-insured corporations.
Each year Health Decisions
investigates over $250,000,000 in claim payments and identifies a recovery
potential of 1-3%. Health Decisions's software is so powerful that it identifies
more recovery cases in an hour than manual reviewers can do in a
week.
Health Decisions, a national leader in group health claim recovery,
serves commercial insurers, HMOs, self-funded companies, consultants, brokers,
union trusts, and government entities.
Among its client lists are Blue
Cross Blue Shield of Michigan, IBA Health Plan, Compuware, Detroit Diesel
Corporation, Elias Brothers, General Motors, Kellogg Foundation, MASCO
Corporation, Michigan Beer & Wine Wholesalers Assn., R.L. Polk, Oakwood
Health Services, St. John Hospital, the cities of Detroit, Ann Arbor, Pontiac
and several school districts.
"When we take a look at the last 2-1/2
years, Health Decisions has recovered in excess of $128,000 for only $52,000 in
expense," says Richard A. Gasowski, director of risk management and safety for
Macomb County.
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 are not the client's responsibility. This
service routinely produces a positive return-on-investment, says
Nahra.
In addition to claim recovery, Health Decisions conducts a formal
audit of claim payer procedures and performance and identifies and corrects
errors or omissions made by claim payers that are increasing plan costs and
legal liability.
Health Decisions also offers specialized staff to
conduct a complete Enrollment Verification Survey of all covered persons with
the full range of information needed for claim administration and regulatory
compliance, including new HIPAA regulations.
"Employers using our
services can save 1-3 percent of paid claims by finding facts that were not
known when the claims were originally paid," explains Nahra. "Companies also
will improve employee relations by helping them get the full value from all
coverages due them. And we will help employers avoid federal and state
regulatory liabilities."
"Most insurers have taken traditional
cost-containment efforts to the limit," says Judy L. Mardigian, Chief Executive
Officer of Health Decisions, Inc. " Benefit design changes and creative
financing arrangements no longer provide the savings that are needed in today's
highly competitive benefits marketplace."
The only way to reduce risk and
improve profitability is to lower actual claim costs, stresses Nahra, and that
is exactly what Health Decisions does. "Some insurers already have claim
recovery efforts in place for subrogation or other areas," says Nahra, "Health
Decisions does not disrupt or change these existing relationships. We perform
our reviews and pursue only those claims not already identified by existing
recovery efforts."
Data in Health Decisions’s system is edited, checked
for accuracy and reconciled to assure quality data that complies with HIPAA and
other regulatory requirements. The data is integrated with external files to get
all available facts and is converted into Microsoft Word, Excel and
web-compatible formats.
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, Inc. services and its pioneering
Post Payment Administration program go to www.healthdecisions.com,
send an inquiry to Health Decisions@healthdecisions or call 800.589.2500.
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Source : http://www.prweb.com/releases/2004/10/prweb163062.htm