LOSS PREVENTION & RECOVERY

We provide the additional services, expertise and proven results that you are looking for to help you manage healthcare costs.
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Fee Negotiation

HealthComp’s Cost Containment Department engages in direct negotiation of non-network claims, and some network claims when permitted. These negotiations utilize data from other pricing sources and scrutinization of itemized bills to identify excessive or improper charges. These direct savings benefit both the member and the Plan, and are done on a percentage-of-savings basis, no additional up-front costs or expense to the Plan.

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Coordination of Benefits

HealthComp helps you ensure proper coordination of benefits, which can save your Plan from unnecessary expenses. We annually verify other insurance information from members which reduces the number of claims paid improperly as primary and saves the Plan money. HealthComp also reviews received claims to check for indications that there are other insurance policies covering the member which should be coordinating benefits.
HealthComp also performs the mandatory CMS §111 Reporting on behalf of clients, and assists with any Medicare or Treasury demands for reimbursement.

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Stop-Loss Services

HealthComp provides comprehensive stop-loss reporting for our clients, including submission of claims to carriers and preparation of disclosure statements. HealthComp’s in-house attorneys will also provide support to assist in appeals of denied reimbursement claims when necessary. Upon request, HealthComp will assist Plan Sponsors by obtaining quotes from other stop-loss providers.

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Eligibility Audits

Each year Plans expend millions of dollars on individuals who were improperly enrolled on their Plans. HealthComp provides a comprehensive dependent eligibility audit program designed to preserve the Plan’s assets by ensuring that ineligible individuals are not improperly enrolled on the Plan: former spouses, girlfriends/boyfriends listed as a spouse, former step-children, nieces and nephews claimed as children, etc. HealthComp can work with you to determine how the Plan wishes to treat improperly enrolled dependents and how to help prevent recurrence.

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Subrogation

  • In-House Management with In-House Attorneys
    • HealthComp provides comprehensive, in-house subrogation management. Our in-house attorneys have developed Plan Document language, and with our IS Department have created a custom subrogation file management that helps maximize reimbursement for your Plan. Our attorneys also negotiate reimbursement amounts with the member’s attorney using case law and the Plan Language to obtain the best result possible, which will be communicated to you for approval. That communication will include all factors affecting the reimbursement amount and our recommendation on acceptance or rejection of reductions to the reimbursement amount.
  • “Pend and Confirm” vs. “Pay and Chase”
    • Unlike many Plans which pay accident-related claims and then attempt to pursue recovery (“Pay and Chase”), our approach is to identify claims which may be accident-related, pend the claims, contact the member to confirm whether an accident occurred, and then obtain the member’s written acknowledgment of the Plan’s reimbursement rights prior to paying claims (“Pend and Confirm”). This approach, while more time-consuming, helps to maximize the reimbursement the Plan is entitled to receive. Specific Plan Document language has been developed by our attorneys to make this possible.
  • Benefits of In-House Subrogation
    • Because subrogation is being handled by the same entity processing claims, the process is more efficient and results in higher recovery rates for the Plan. And because HealthComp is familiar with the Plan Document’s exclusions, we are often able to identify such exclusions while reviewing accident information, such as recognizing that a member was under the influence of alcohol or drugs while driving, or was injured while in the commission of an illegal act. Without such advance screening, utilizing an outsourced subrogation entity might result in the claims having been already paid and leaving no chance of reimbursement—which can lead to significant costs for the Plan.
  • Cost
    • Subrogation management services are a part of the Enhanced Cost Containment option, with fees of 30% of the amount actually recovered by the Plan. There are no additional costs for access to the specially-developed Plan Language, or for updated language based on changing case law.