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Case Study: Strategic negotiations
A large carrier offering plans with an aggressive Medicare-based benefit limit sought: to satisfy clients seeking greater protections from balance billing for their plan members; to preserve the underlying cost benefits of the out-of-network reimbursement methodology
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Case Study: Retaining important business
Claritev analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by: significantly improving savings for the employer and its members; engaging important providers in the new process; and preserving the community’s provider-patient relationships.
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Case Study: Fixing vs. paying improper charges
Claritev analysis uncovered opportunities for a third-party administrator using a variety of PPO networks to: improve payment accuracy – too much was being missed in the existing editing process; gain control over clinical billing waste and abuse; and minimize provider abrasion to preserve leased network relationships.
Category: Claims-Intelligence-Solutions
