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 especially on higher dollar in-network and out-of-network claims. When that happens, they have HHC Group review the claim.

Our attorney case managers start by examining the claim to identify any obvious errors. Then they search published databases and HHC's proprietary database to determine an appropriate payment amount for the services rendered. If they find the billed amount is reasonable, we recommend the payor remit that amount. If we find that a lower amount is appropriate, we work with the provider and the payor to settle on the amount to be paid. Once the provider agrees to the adjusted amount, they send us a signed document acknowledging that they accept that amount as payment in full.

Claims Repricing. HHC Group Getting 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 tap our PPO partners' agreements with over 1.2 million professionals and 6.5 thousand facilities to accept discounted rates on out-of-network claims as payment in full for their services. Importantly, to maximize savings we employ customized network routing based on the strength of the PPOs in each client's markets. Finally, we validate the discounts on exceptionally large claims to avoid costly reversals-and added work for all parties - all within 5 business days. HHC helps with:

• No patient balance bills.
• Customized routing.
• Less than 1% reversals.