Payers

Throughout the implementation and roll-out of the Affordable Care Act, self-funded groups have been largely exempt from many of the mandates.

With more and more consumers coming on to insurance rolls–many for the first time–costs still need to be managed on both sides.

There have already been notable increases in:

• Repeat Admissions
• Non-Compliant Patients
• Unsatisfied Patients
• Bad Debt

Self-funded groups and their Third-Party Administrators (TPA)

We serve as an extension of their customer service team by helping their members navigate their healthcare use and find the needed resources for them as they journey through it. Additionally, our disease management team provides services that help high-risk patients remain compliant in the respective treatment protocols.

Finally, with the implementation of ICD-10, billing for services will become even more complex. Our audit team will review medical bills for errors and overcharges and negotiate final payments to providers.

The services we provide include:

• Review and audit medical bills
• Address denials and appeals
• Liaise with providers