Self-Insured Employers and Health Insurance Payors Benefit From Health Decisions, Inc. Pioneering Post Payment Administration Service

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Health Decisions, Inc. has pioneered Post Payment Administration. After everyone else is finished looking for charges HDI applies their expertise, methodology and powerful software tools to dig deeper uncovering more money for self-insured companies and health insurance companies. Post Payment Administration finds money to recover after health claims have been paid by insurance companies or self-insured companies. Health Decisions software is so powerful that it identifies more recovery cases in an hour than manual reviewers can do in a week.

Given the rising costs of health care and intensive competitive pressures in the market, why wouldn’t any savvy employer or health insurance company be interested in doing a better job processing claims for healthcare services?

Many self-insured employers and health insurance payors believe that the best opportunity to generate additional income is to be more aggressive in health claim recovery, to be sure only claims actually owed are paid.

But the fact is that there is a far greater potential for cost reduction and cost containment when claim recovery is coupled with aggressive eligibility verification.

Health Decisions, Inc. of Plymouth, MI, has demonstrated again and again to its clients that verifying enrollment information will produce far greater savings than ever can be realized by strengthening claims recovery process.

“The real money to be saved in claims recovery is always identified through enrollment verification steps,” stresses Si Nahra, Ph.D., founder and president of Health Decisions, Inc.

Health Decisions always identifies a significant number of recoverable claims that slip through the system and then follow up to return the money to its client. But the firm’s greatest success achieved for clients is to identify missing enrollment data so more and more claims are paid correctly the first time.

“During our initial contact, very few of our prospective clients believe us when we say that the money we will save them with our enrollment verification service will be far greater than the significant amounts of money we will help them save in claims recovery,” adds Nahra. “But after experiencing our revolutionary and pioneering Post Payment Administration system almost all our clients become convinced we are correct in making this assertion. We plug the holes in the dam.”

Health Decisions, Inc. is a pioneering company because it is the first and only one involved in Post Payment Administration. “After everyone else is finished looking for charges,” says Nahra, “we apply our expertise, methodology and powerful software tools and dig even deeper to uncover more money for self-insured companies and health insurance companies.”

Post Payment Administration finds money to recover after health claims have been paid by insurance companies or self-insured companies. Health Decisions software is so powerful that it identifies more recovery cases in an hour than manual reviewers can do in a week.

Enrollment Verification, when done properly, involves a comprehensive review of enrollment information to eliminate ineligibles, correct payor errors, and update enrollment records to reduce costs and legal liabilities.

Internal payroll and Human Resource files provide the basis for initial reconciliation with payor records to eliminate ineligible employees. Payor records from multiple plans are reconciled to assure non-duplications, payor enrollment files are reconciled with payroll and employer rosters, and enrollees and covered members are surveyed to confirm and update all relevant facts. The key areas surveyed include coordination of benefits, any unknown divorce decree, existence of Medicare coverage, and dependent status of family members.

Health Decisions, Inc., offers an employer or insurer use of its specialized staff to handle all the logistical details associated with an Enrollment Verification Survey of all covered persons.

The survey is sent to all employees, retirees, spouses, and dependents to get the full range of information needed for claim administration and regulatory compliance. Amazingly, Health Decisions for more than 10 years has achieved response rates of 90 percent on its purely voluntary surveys.

Despite the potential benefits to clients, most firms engaged in claim recovery services simply do not get involved in enrollment verification. “We are the only ones doing enrollment reconciliation in the payor market,” says Nahra, “and in the employer market there are very few, if any, who come close to doing as comprehensive an enrollment reconciliation as we do with comparable results. We offer a total solution, not just a recovery initiative,” adds Nahra, “and enrollment verification is a key tool employed in seeking total solutions.”

About Health Decisions:

Health Decisions, Inc., a privately owned, Michigan Corporation, specializes in benefit data management services to clients throughout the country.

Since 1985, Health Decisions, Inc. has successfully served hundreds of clients -- HMOs, insurers, TPAs and self-funded groups of all sizes. The firm successfully processes annually more than a billion dollars of paid claims data and processes special surveys for more than 225,000 covered members.

Health Decisions has taken its core competencies of technical expertise, data sophistication, and a pragmatic service orientation and developed a series of products with proven value and considerable potential for growth.

Health Decisions, Inc. distinguishes itself with its service philosophy: Respect for existing procedures; emphasis on customization; and, focus on solutions

For further information about Health Decisions, Inc. Enrollment Verification services and its pioneering Post Payment Administration program go to, send an inquiry to hdi@healthdecisions or call 800.589.2500.

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Scott Lorenz