Claims Negotiation and Repricing

Claims Negotiation. HHC Can Help.

Sometimes, payors are not sure if providers have billed an appropriate amount for the services they deliver on higher dollar in-network and out-of-network claims. When that happens, they have HHC Group review the claim. If we believe a lower amount is reasonable. we inform the payor. If we believe a lower amount is appropriate, we collaborate with the parties to have the provider adjust their bill to a mutually acceptable amount.

Our attorney case managers start by examining the claims to determine if they contain any obvious errors. Then they search published databases and HHC's proprietary data to determine an appropriate payment amount for the services rendered. If we determine the billed amount is reasonable, we recommend the payor remit that amount. If we find that a lower amount makes sense, we work with the provider and the payor to agree on the amount to be paid. Once the provider and the payor agree to the adjust amount, the provider sends us a signed agreement acknowledging that they accept the adjusted amount as payment in full.

Claims Repricing. HHC Can Get the Job Done.

Many providers have signed agreements with preferred provider networks (PPO) to accept a reduction in their bills in exchange for patient steerage and prompt payment for their out-of-network claims. We turn to our national, regional, and local preferred provider network (PPO) partners. We tap their agreements with over 1.2 million professionals and 6.5 thousand facilities to accept discounted rates as payment in full for their services. Importantly, we customize network routing based on the strength of the PPO in each market. Finally, we validate the discounts on very large claims to avoid costly reversals-and added work for all parties,-all within 5 business days. HHC help with:

• No patient balance bills
• Less than 1% reversals