To improve competitiveness, a regional provider-owned health plan needed assistance with: extending network access for its highly mobile membership, containing out-of-network medical cost, and preserving its relationships and reputation with the local provider community.
Claritev analysis showed a property and casualty servicer how it could strengthen its bill review and network services by: using analytics tuned to find wasteful or abusive medical billing practices not identifiable by more automated bill review programs; implementing resolution strategies appropriate for the severity of issues and nature of the provider relationships.