Contain out-of-network costs
Out-of-network costs represent substantial expenses for most payers. Options for addressing these challenges are limited to balance billing and repricing that can lead to lengthy appeals and financial loss, or to a negotiation process that strains provider relationships and complicates the expansion of your network. Most organizations lack the internal resources to effectively recapture lost revenue. Ingenix can help. Our cooperative strategy yields signed agreements, no appeals, and perhaps most importantly, stronger relationship with you, your providers and memebers.
Cooperative strategy
- Complete and transparent claim resolution contracted in writing
- Complete bill review by expert clinicians and coders
- Skilled negotiators with years of expierence working directly with providers nationwide
- Stronger working relationships with direct, hands-on negotiation approach for each claim
- Contingency-based services in which payers are charged only when a fee is collected
Pre-Claim Fee Negotiation Service
In our Pre-Claim Fee Negotiation Service, management of the claim is typically initiated at the utilization management, care management, or pre-certification phase. Our highly skilled negotiators then work with the facility to contract favorable agreements and considerable discounts. With this focus on the front end of medical care, payers benefit from a substantial savings—historically averaging more than 30 percent.
Post-Claim Fee Negotiation Service
In our Post-Claim Fee Negotiation Service, all received claims are reviewed and settled directly with the provider or facility. Our team of audit nurses and professional coders review each claim for overcharges, inappropriate charges, billing errors, and excessive charges. Using normative charges as a benchmark, these reviews are performed by comparing other providers’ fees and by using historical proprietary data. Because we base negotiated amounts on plans’ allowed charges, historically, we have been able to find an average discount of 23 percent on 60 percent of claims submitted while simultaneously eliminating balance billing and costly appeals, as well as reducing overall administrative.
