Comprehensive Review of Health Claims Results in $4.3 Million Saved for TPA Clients

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With an ongoing focus to contain the costs of health plans, Cypress Benefit Administrators reports saving clients $4.3 million last year through its comprehensive health claim review service. Coding error identification and out-of-network reviews were among the top ways the most savings were identified.

Cypress Benefit Administrators
It’s incredible to see how much money can be saved by taking a closer look at health claim charges.

A third party administrator (TPA) based in the Midwest, Cypress Benefit Administrators has announced that its Argus Claim Review division was able to save employer-clients $4.3 million on health claim costs last year.

The Argus team achieved these savings by scrutinizing health claims for errors and overcharges as part of the third party administrator’s ongoing efforts to contain costs on behalf of its clients and their self-funded health plans. Claim analysts found the savings through things like miscoded items, duplicate entries, upcoded services, unbundled charges, medical necessity analysis and fees for services that were never administered.

In reviewing and negotiating client claims, Argus has saved employers an average of $1,391 per file reviewed and 61.5% on billed charges. It found the most savings this past year via out-of-network and medical necessity reviews as well as coding issues and line item audits.

“It’s incredible to see how much money can be saved by taking a closer look at health claim charges,” explained Tom Doney, president and CEO of Cypress. “A simple coding mistake can cost an employer hundreds or thousands of dollars if it isn’t caught.”

Out of the $4.3 million Argus was able to save for its employer-clients for the year, the top three savings amounts by company added up to $627,000, $515,000 and $298,000.

Cypress’s Argus division also had success with its health claims negotiation efforts. Considering all cases where adjusted payments were made, only 2.81% of them were appealed. This means that the payment amount Cypress calculates as appropriate and submits for claim charges is accepted more than 97% of the time. Additionally, when Cypress’s adjusted payments are appealed by a claims issuer, they are upheld 82% of the time.

“These negotiations are a big part of the savings story,” Doney said. “It’s not just a matter of identifying where money can be saved on a claim, but also doing a good job of determining what the appropriate payments should be.”

As health care evolves and claims become more complex, some of the areas Argus is now focusing on in the review process include lab services, ICD code additions and SPECT testing.

About Cypress Benefit Administrators
A privately held company headquartered in Appleton, Wis., Cypress Benefit Administrators has been pioneering the way toward cost containment in self-funded health benefits since 2000. The third party administrator (TPA) is the country’s first to bring claims administration, consumer driven health plans and proven cost control measures together into one package for companies ranging from 50 employees to thousands of employees. It serves employer-clients across the U.S. with additional locations in Portland, Ore., Omaha, Neb. and Denver, Col. For more information on Cypress and its customized employee benefits, visit

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Dave Willems
Willems Marketing & Events
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Tom Doney
Cypress Benefit Administrators
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