skip to Main Content

The Benefits of Health Insurance Claims Repricing

You might have gone to the hospital for a minor treatment, but left the hospital with a huge medical bill. You cannot make sense of the billing, and you may have a feeling that you should not be paying that much. If you have health insurance, this will not give you sleepless nights as you can seek health insurance claims repricing services.

What Are Claims Repricing Services?

Also known as care network repricing insurance, health insurance claims repricing, is the go-to plan for reasonably-priced health insurance for companies and individuals. Today, most people prefer health insurance claims repricing as the best-fit alternative for traditional health insurance. Health claims administrators utilize varying strategies to reprice insurance claims. Preferred provider organizations (PPOs), is the most utilized health insurance claim repricing plan. This medical repricing plan applies a fixed fee to a medical claim, allowing group health providers to discount payable claims through restructuring.

Health insurance claims repricing is gaining traction in the United States, as more people seek better health insurance. Third-party administrator healthcare service makes health insurance more affordable to a larger group of people. The surge in demand for medical repricing is timely, given that in 2018, 27.5 million Americans did not have any health insurance plan throughout the year. High health insurance costs are part of the reason 8.5% of people do not have any insurance plan in place. Health insurance providers seek medical repricing services to ensure that they pay the right amount in medical claims — hence, keep insurance costs affordable.

Although medical repricing can be difficult and strenuous to a health claims administrator, the benefits of the process trickle down to the customers. Without health insurance claims repricing, the health insurance costs may weigh down an individual or a company. Hospitals utilize different treatment codes in their computerized method of preparing a medical bill. As the process is quite dutiful, a slight error may lead to a huge difference in the final price that you have to pay for. However, medical repricing does not only resolve accounting errors but also attracts favorable discounts.

Here are more benefits of health insurance claims repricing.

1. Accurate Billing

Due to the huge amount of paperwork involved in medical billing, errors of commission or omission are common. This leads to significant losses in terms of overpayment or underpayment of insurance claims. For a group health provider to offer the best client services, such errors must be eliminated so that operational costs are kept at a minimum. Medical repricing helps health insurance providers better manage their business by eliminating any procedural errors that may increase the cost insurance claims.

2. Easy and Fast Fraud Detection

Just as in any other business sector, there are players in the medical industry who are not honest in their practice and result in cutting corners. Some doctor clinics or even largely established hospitals may conspire to rip off an insurance provider by overstating claims. For a busy health insurance provider, this may not ring a bell instantly, as the increase in claims may be subtle but progressive. By the time an insurance provider revisits the claims, they might have already overpaid for long. However, medical repricing will spot such errors, as the claims restructuring process is more vigorous and accurate.

3. Analyzes Insurance Data in More Depth

Health insurance claims repricing provides for crucial insurance data that may be referenced in the future or on a day to day basis. The process of medical repricing involves analyzing every detail of an insurance claim. As a result, health claims administrators go through numerous paperwork correcting and restructuring claims. This provides a pool of crucial data that health insurance providers can utilize in their businesses. Through medical repricing, a health insurance provider may adopt a new strategy of checking and validating claims.

Health insurance claims repricing is essential for both health insurance providers and their customers. When health insurance companies take full advantage of medical repricing, they’ll experience more cost-benefits in terms of reduced insurance claims and pass down the benefits to their customers.

×Close search
Search