Recovery Of Overlooked Health Insurance Claims Helps Self-Insured Companies, Insurers and HMO’s Save Money

Share Article

Health Decisions, Inc., of Plymouth, MI, has routinely produced a positive return-on-investment for its clients (self-funded employers, insurers and HMOs). A review of 100 percent of claims in more than 30 areas identifies and recovers claims paid by clients' plans that are not their responsibility.

For 20 years Health Decisions, Inc., of Plymouth, MI, has routinely produced a positive return-on-investment for its clients (self-funded employers, insurers and HMOs). A review of 100 percent of claims in more than 30 areas identifies and recovers claims paid by clients' plans that are not their responsibility.

In one year alone Health Decisions reported reviewing claims totaling $261 million for selected clients. Of the total reviewed, Health Decisions’ powerful software identified $76.7 million that warranted further investigation. Expert review using Health Decisions’ unique Paperless Case Review discovered $13.8 million that could lead to recovery. Of that total, $9 million in claims were actually recovered.

“Health Decisions requires no change in existing business practices,” says Si Nahra, founder and president. “Our flexible business arrangements provide monthly feedback and clear remittance reporting. Our clients determine the level of involvement that is right for them.”

Health Decisions’ specialized staff conducts an Enrollment Verification Survey of all covered persons (employees, retirees, spouses, and dependents) not only to support claim recovery but also to get all the facts needed for claim administration and regulatory compliance. The firm has routinely achieved response rates of 90 percent on a purely voluntary basis.

For employers Health Decision's pioneering Post-Payment Administration has these benefits: performs in-depth audits that can produce positive return-on-investments; saves 1-3% of paid claims by finding facts that were not known when claims were paid originally; avoids federal and state regulatory liabilities; improves employee relations by helping them get the full value from all coverages due them.

For health insurance companies and other payors, Post-Payment Administration benefits includes: saves 1-3% of paid claims directly and/or for clients by finding facts that were not known when claims were paid originally; simplifies internal management by extending span of control across organizational units without reorganizing; simplifies external management by providing a common case review tool to facilitate multi-party discussions and reviews; manages the growing reliance on auto-adjudication to get the speed of auto-adjudication with the customized touch of post-payment review; earns new service fees by offering self-funded clients new data and support services; institutes progressive approach to Continuous Quality Improvement; and, establishes Medicare recovery capability.

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. services, including its pioneering Post Payment Administration program, go to http://www.healthdecisions.com, send an inquiry to hdi@healthdecisions or call 800.589.2500.

###

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Scott Lorenz
Visit website