Working with a health insurance claims repricing agency is beneficial to your bottom-line, whether you are a health insurance provider or an individual. Health claim administrators help health insurance companies reduce the cost of claim processing and provide better services to their clients. The top medical repricing insurance agencies will offer the following client services.
1. End-to-End Claim Processing
There’s so much paperwork involved in claim processing. As an insurance provider, you must first ensure that all ancillary needs are met before processing a claim. If you also use a repricing plan such as PPO (preferred provider organization) you’ll have extra work to do before processing the claim because you have to discount the standard fees.
Luckily, a group health provider will handle the vigorous medical claim processing on your behalf. This enables you to offer better services to your clients while keeping the operational costs at a minimum. Health claim administrators achieve this by first analyzing your current claim program and then designing a claim management program that suits your company’s needs appropriately.
2. Care Network Repricing
Claims repricing is important for health insurance providers because it helps them avoid extra and unnecessary costs. Although most healthcare providers use computerized claims processing methods to generate medical bills, errors of commission or omission are common. Especially for the busy hospitals and clinics with many clients, the paperwork involved in claim processing can be overwhelming. As such, it’s easy for healthcare institutions to make small billing errors that can have huge cost implications.
For instance, a hospital may use the wrong treatment codes that don’t match those in your medical claims repricing program. This leads to underpayment or overpayment of medical claims, which is bad for your health insurance business. Good thing group health providers offer care network repricing as part of their client services. By utilizing health insurance claims repricing services, you’ll not only save money but also process your claims more swiftly.
3. Network Referrals
The reputable care network repricing insurance companies have vast networks with many PPOs around the country. Technically, your health insurance company and a medical repricing agency have the same customer base. A good health repricing company may refer more customers to your insurance agency once you use their services.
Today, most Americans have health insurance coverage. As of 2018, about 91.5% of people had health insurance coverage, which was slightly lower than in 2017 where 92.1% were covered. This has also seen the demand for medical repricing services rise as people seek affordable health insurance. As such, having a good working relationship with a medical repricing company will earn you new business. The top repricing agencies attract international insurance carriers, international employers, and national and international third-party administrator healthcare agencies. These are the high-profile clients that your health insurance company may tap by working with a medical insurance claim repricing agency.
4. Auditing Services
It’s easy for a health insurance company to get short-changed and overpay medical claims. Some dishonest healthcare providers may inflate insurance claims using technicalities that your staff may be too busy to notice and flag. Some errors that medical repricing uncovers include over-billing, up-coding, unbundling of laboratory tests, double billing, bilateral surgeries, unrelated diagnosis and treatment, and errors in room charges. These are the areas that your team may not have enough expertise or time to conduct extensive audits.
In the long term, these audits will save you a substantial amount of money by ensuring that your company only pays for the services that your clients received. Medical insurance fraud is common and it can cost you tons of money down the line if you don’t detect it early. Claims auditing is one of the crucial client services offered by medical repricing companies.
As a healthcare insurance provider, your goal is to provide client services while keeping your operational costs low. Working with a healthcare insurance claims repricing agency will keep your clients satisfied and also save you time and money.