Health Plan Success

One of our health plan clients approached us to find a system to increase their ability to better compete in their market relative to out-of-network claims as well as their wrap network discounts. In order to fully understand their position, we analyzed their past few years of claims data and quickly identified discounts and billing discrepancies that if captured could achieve significant savings. We quickly assumed the role as their new bill review vendor.

In the first year and every year following, HCC has achieved an additional 35% savings on their out-of-network and/or PPO wrap network claims. Our average savings per claim reviewed is just over 69% which results in an average annual net savings to the health plan of $4.5 million. This savings over the past two years, has essentially accounted for their total annual profit for the entire health plan.

This health plan client has been a true partner over the past several years. We continue to work with them in analyzing their claims and forming strategic initiatives to help increase their savings now, and for years to come.

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Average Annual Savings

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Savings on out-of-network and/or wrap network claims

adminkenHealth Plan Success