Health Decisions’s pioneering ‘Post Payment Administration’ system helps insurance companies cope with rising cost pressures

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Health insurance companies can reduce risks and improve profitability by lowering actual claim costs utilizing a Post Payment Administration system offered by Health Decisions Inc. of Plymouth, Michigan

Most health insurers have taken traditional cost-containment efforts to the limit but generating the level of savings needed in today’s highly competitive benefits marketplace remains a challenge.

The best way to reduce risks and improve profitability is to lower actual claim costs – and that is exactly what Health Decisions, Inc. of Plymouth, MI, can do for health insurance companies. Health Decisions offers the most comprehensive Post Payment Administration system in the industry.

“Some insurers already have claim recovery efforts in place for subrogation or other areas,” says Si Nahra, the firm’s founder and president. “Health Decisions does not disrupt these existing relationships. We pursue only those claims not already identified by existing recovery efforts, and typically return an additional 1-3 percent of claims in recoveries.”

No system, no matter how good, can compensate for the pressures for quick claim turnaround that prevents full investigation of all claims prior to payment. Because Health Decision’s review does not start until after a claim is paid it has the time to look into the difficult to document details that lead to recoveries.

Health Decisions goes much deeper seeking claims to recover by conducting a review of 100 percent of claims in more than 30 areas to identify and recover claims paid that is not the payor’s responsibility.

Health Decision’s approach to claims recovery works so well because it:

  •     Combines existing data files from various sources to identify cases that fit recovery profiles in dozens of areas from Coordination of Benefits and subrogation to Medicare recoveries, divorce decree enforcement, and provider payment verification.
  •     Delves into the details of each case to find facts not known when the claim was paid. Tools we use include special surveys, verification calls, and independent documentation.
  •     Doesn’t stop until a claim is collected or closed. Its collections do not involve individual enrollees. Instead, Health Decisions focuses on other plans, providers, Medicare and judicial judgments to get recoveries.
  •     Tracks and accounts for those recoveries using Health Decisions’ automated credit tracker tool that can account for all outstanding recoveries from any source.

“The insurer selects the level of involvement desired from us,” says Nahra. “Or Health Decisions can train an insurer’s staff to do recovery internally and license its Claim Recovery Software Suite for the client’s use. For those clients with recovery efforts in place, we coordinate with these efforts to avoid duplication.”

Because Health Decisions is at the cutting edge of technology it helps insurers better deal with:

  •     The fallout of automated adjudication of claims
  •     Fraud and abuse detection and prevention
  •     Medicare recovery
  •     Identifying the best Continuous Quality Improvement (CQI) solution
  •     Satisfying HIPPA and other regulatory requirements

Health Decisions Post Payment Administration system for payors includes emphasis on span of control, financial return, staffing, implementation, and CQI. Its suite of services covers data handling, data processing, case investigation, and case updates.

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 Post Payment Administration services for insurers go to, send an inquiry to hdi@healthdecisions or call 800.589.2500.

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Scott Lorenz
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