Health Claims Management

Disrupting the status quo

Health Claims Management is a comprehensive approach for self-funded employers to impact their claims cost. It includes our Cost Containment products and Risk Management Service. Business as usual has not produced the claims savings results most employers are looking for, so let’s change the status quo! We take a limited amount of data and create a transparent environment where all stakeholders can see our process and verify our results. Now we can offer employers and employees guaranteed savings, and an action plan to access those savings.

Yes, we impact claims costs!........How do we do it?

  • Change in the Status Quo-We provide employers and employees with access to International Pharmacy, Single Case Direct Contracting, and Direct            Cash Payments which are the engines that drive health claims savings. 
  • Take What the Defense Gives You-We identify about 5% of claims which can be paid outside of the traditional PBM or Claims Payor model, at a                significantly reduced cost. We do not interrupt current PBM, Claims Payor, or Stop Loss relationships.
  • Transparency-Current employer claim cost and our costs (and savings) for the same service are identified and shared with the employer and the                  employee, creating process integrity and credibility. No more fuzzy ROI calculations.
  • Shared Savings-Whether it is waiving out of pocket expenses, cash payments, or both, employees always share in the savings created by our                         products. This increases engagement and supports a positive win/win approach.
  • Voluntary-In most cases employees may have to change the way in which they enter the healthcare system to access the discounts and the resulting           shared savings, so they will always be given the unfettered choice to participate, or not.
  • No PE/PM Cost-There is no PE/PM cost for the employer. Shared savings with employees and our fees are contingent upon the savings amount, so               employer costs are incurred only when an employee engages and the savings far exceed the expenses.
  • Willing Buyer and Seller-We negotiate with providers on an individual case basis to deliver their services at a reduced cost. Final cost and payment           are agreed upon before the services are provided.