Meet Repricing Insights™.
Out-of-network claims happen, even with the best plan language and member support in place. On the high end, those can make up 15% of your total claims and those dollars can add up.
Concerned? Keep reading. We’ve got your back.
How we do out-of-network repricing.
Unlike most TPAs or carriers that work with third-party cost containment vendors on out-of-network repricing and reimbursement, our service is in-house and fully integrated with our self-funded solution. Basically, we can ensure a seamless and more efficient approach to out-of-network repricing, resulting in fair costs and better savings for our clients.
More control. Less hassle.
- Fewer headaches and delays associated with third-party vendor integrations
- More efficient claims processing
- Claim status transparency through the entire process
- Adherence to your plan language, plus additional research powered by Pricegauge™, our in-house platform
What does this mean for our clients?
With the right plan language and out-of-network repricing methodology in place, we’ve seen an average savings of up to 60% on out-of-network claims.
Contact us to make this a reality for yourself.
Let’s take a look at the journey of an out-of-network claim.
With the other guys:
When members receive care, claims are typically sent to their PPO network to be repriced before then going to the TPA to adjudicate the claim.
Out-of-network claims follow the same path but come to the TPA “un repriced.” The TPA follows the repricing methodologies outlined in the plan language to reprice the claim, but they aren’t always able to negotiate substantial discounts and they often work on autopilot, meaning less transparency and no claim research.
With Maestro Health:
Out-of-network claims are sent to our in-house Repricing Insights team where reimbursement specialists apply our proven methodologies alongside your plan language to reprice claims.
What does this mean for clients? With the right plan language and out-of-network repricing methodology in place, we’ve seen an average savings of up to 60% on out-of-network claims.
Here’s how we do it.
The starter kit for any healthcare plan. With these basic, foundational administrative solutions, your self-funded healthcare plan begins to come to life. These are the first step to taking work off your desk while giving you the power to make your own decisions.
These are the eggs to the omelette. What you build on it is up to you.
- Service Support for employers, employees and providers
- Standard employee education and engagement
- Access to My Benefits web portal and mBENEFITS mobile app
- Large claims management and adjudication (including stop-loss)
- Paper & electronic EOBs
Pricegauge™, our in-house repricing platform, gathers data to help us get the full picture for the claim. This helps us to get you the best savings by leveraging:
- Market data
- Industry standards
- Our proprietary methodologies
- Your plan language
Our reimbursement specialists will reprice the claim leveraging your plan language alongside our standard and proprietary methodologies to ensure you’re paying a fair price. We document the entire process, including negotiations.
Analytics & Reporting
Our team is here for your team, including after a claim has been repriced and paid out. When needed, we provide:
- Appeal responses
- Documented and custom client and member communication
- Dispute resolution
Ditch the autopilot.
Our experts partner with you to look at the whole picture, from the plan language you have in place to your overall cost management goals. We’ve got your back with cost management strategies designed around your needs.