Controlling Health Plan Costs
With the cost of health care continuing to rise, MedCost Benefit Services recognizes the importance of effective cost containment strategies. Our subrogation services, out-of-network fee negotiations and fraud, waste and abuse program help to ensure that our clients’ health plan costs are kept in check.
MedCost Benefit Services manages all the details of subrogation for our clients, including contacting at-fault parties, insurance adjusters, and personal injury attorneys; providing any documentation from the investigation; and collecting the amount owed (which could include filing a lawsuit or using a collection agency). Subrogation can be time-consuming to complete, but we work with highly experienced attorneys to resolve issues as quickly as possible on our clients’ behalf.
Out-Of-Network Fee Negotiations
Through strong relationships with national and regional networks, as well as seasoned in-house claims professionals, MedCost Benefit Services can help our clients realize additional savings on their out-of-network claims. Effective fee negotiations can result in significant cost savings for our clients.
Fraud, Waste And Abuse Services
MedCost Benefit Services is committed to protecting our client’s bottom line through detecting and preventing fraud, waste and abuse (FWA). FWA includes billing for services that were not rendered or equipment that was not provided, providing services or items that were not necessary for the proper care of an individual, or obtaining multiple prescriptions for narcotic painkillers by going from doctor to doctor.
Our Process To Support Detection And Prevention Includes:
- Real-time adjudication edits to detect provider billing patterns that are inconsistent with industry standards
- Retrospective provider claim filing analysis
- Validating provider credentials
- Medicaid claim screening
Employers should encourage health plan members to protect themselves from FWA by thoroughly reviewing Explanation of Benefits (EOB). Any suspicious activity should be reported right away.