Claims Review
Claims Review
- Verification if claim was processed correctly
- Claims reprocessing
- Pre-authorization coordination
- Quarterly claims audit
Coordination Of Care
- Pre-service consultation
- Post-visit care coordination limited to Labs
- Post-visit care coordination expanded
Policy Management
- Add/Remove dependents
- Cancellations
- Open enrollment plan charges
Rx Home Delivery Coordination
- 90 Days medication coordination
- Step therapy review and escalation for RX
Claims Negotiation
Claims Negotiation
- Negotiated items under $500 at no charge (covered services only)
- Negotiated items $500 - $1,000 at 10% charge of savings
- Negotiated items $1,000 and up at 20% charge of savings
- Foreign (NON-USA) claims / one time negotiation contract*
Instructions For Utilization
- Basic introduction on how to navigate your plan
- Expanded Preventative health code list
- Health code list including colonoscopy and endoscopy
Case Management
- Post exam follow up call
- Dedicated concierge rep
- Newsletter (FYI)
Our Benefits
- Help navigate the insurance maze
- Help file health insurance claims
- Manage or reduce your hospital and medical bills
- Negotiate denials of claims, hospital and medical bills
- Identify gaps in care and underlying issues early
- Educate on preventive care importance
- Increase benefits knowledge
- Collect vital data and contact preferences
- Facilitate care coordination
- Engage with case management
- Improve ER utilization
- Strengthen the member relationship
- Track Paperwork and Records
- Dental & Vision Advocacy
- Uncover and assist with healthcare compliance obstacles such as transportation challenges, language barriers or financial roadblocks