HEALTH CLAIMS MANAGEMENT

Facility Cost Containment

Inpatient & Outpatient Facility Costs

Our partner negotiates and pays cash for certain inpatient and outpatient facility charges. These claims are paid directly to a willing provider through a single case direct contract. All stakeholders see our methodology, and employees are guided through the process every step of the way:

  • We obtain inpatient and outpatient facility claims data from       the employer/advisor.

  • An employer is provided with a Facility Cost                                  Containment Savings Analysis that identifies the                      inpatient and outpatient facility payments paid, compared          to the average cost reimbursed to that facility.
  • Pricing Transparency is provided by The Rand Study                   "Nationwide Evaluation of Health Care Prices Paid                  by Private Health Plans".
  • The Facility Cost Containment Shared Savings Modeler          is used to determine the employer approved sharing                  formula.
  • The employee provides direction on facility choice(s). We            negotiate with the appropriate facilities.
  •  If facility and minimum savings requirements are met, the         employee has final decision on engagement.