The No Surprises Act and the IDR process present unique challenges for payors and providers – from an inefficient portal to a shortage of IDR entities and constantly changing rules. In this blog post, we discuss the top 8 challenges we’ve encountered and what you can do to address them.
In the property and casualty world, out-of-network medical bills represent a large portion of all new bills — over 50% in some states. So, property and casualty payors must take care in choosing an out-of-network solution. In this post, we list our top five considerations when choosing an out-of-network solution for your workers’ compensation or auto medical bills.
Data Mining, a post-payment payment integrity service, detects errant medical claims in sets of data. Errant claims typically include duplicate payments and claims with billings issues that lead to overpayments. MultiPlan identifies errant claims by scouring the data. We use artificial intelligence, including machine learning and algorithms, to identify incorrectly paid claims and anomalies in the data. We also have subject matter experts on our data mining team review all findings to confirm the findings of the technology. All findings are presented to our clients for approvals.
To tackle the problem of out-of-network charges, Claritev developed our Data iSight pricing methodology. Unlike Usual and Customary (U&C) or Medicare-based repricing solutions, our methodology recommends reductions using both a cost-up approach (for facility claims) and median reimbursement levels (for practitioner claims) to achieve maximum defensibility, wide provider acceptance, and savings of 61%-81% off billed charges.
Subrogation? What is it and what does it have to do with healthcare insurance? Subrogation, in layman’s terms, means a health plan can be reimbursed by the party whose insured was deemed responsible for an accident or injury.
An estimated $1.2 trillion in healthcare spending is attributed to some form of waste or abuse that leads to overcharges. Payment integrity solutions are tools healthcare payors use to help bring down this staggering number. Claritev discusses what these solutions do.
Everyone wants a return to normal. But given all we’ve experienced during this pandemic, going back to “business as usual” seems unlikely. Here are four ways COVID-19 has changed the billing landscape and what we can expect for the future.
An auto medical services provider wanted to distinguish its network-based cost management program to sensitive auto insurance carriers by demonstrating: minimal provider noise through the use of network contracts to reduce medical cost; effective dispute resolution processing.
A workers’ comp services provider needed help maintaining State Certified Managed Care programs by: eliminating provider coverage gaps in geographies not addressed by its proprietary network; strengthening coverage for key medical specialties.
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.