Choose what’s best for your people and your company’s bottom line.
We give you the power to take control of your healthcare costs and manage your own decisions. From ensuring you and your members aren’t paying outrageous healthcare claims costs to giving you more insight into cost drivers and savings opportunities, the cost management component of our self-funded solution is designed to arm you with the tools and support you need to deliver a better benefits experience for everyone—because no two people or businesses are alike.
Here are some of the ways we help you take control:
- Provider network partners
- Out-of-network repricing management
- PBM maintenance for specialty, mail and retail
- Alternative reimbursement strategies like reference-based pricing and direct contracting
- Innovative access solutions like bundled surgeries, narrow networks and virtual care options
- Quality and cost transparency tools
Cut costs, not care.
When it comes to provider network administration, out-of-network repricing management, PBM maintenance, innovative access solutions and alternative reimbursement strategies, you can count on our seamless and efficient approach to cut costs without sacrificing quality.
Nobody should have to pay an unnecessary high-dollar claim.
We offer repricing services and claim auditing to ensure you’re never stuck paying more than you should.
Here are some of the ways we work with providers and our clients to keep prices fair and costs low:
- In-network pricing – Access to a nation-wide network of providers and facilities.
- Direct contracting with providers and facilities – Similar to working with a traditional network, claims are paid using rates agreed upon between the employer and the provider or facility.
- Out-of-network repricing – Claims are repriced using methodologies like standard industry references, supplemental networks and negotiations.
- Alternative reimbursement strategies – When it’s the right fit for our clients, claims are repriced to a fair and reasonable amount for providers and employees using industry baselines, like Medicare and Cost Plus.
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Pricegauge is Maestro Health’s proprietary repricing platform that allows us to examine the unique state of a local market’s billing practices and reimbursement results, recommend plan language and reprice both in-network and out-of-network claims. With the right plan language and out-of-network repricing methodology in place, we’ve seen an average savings of up to 70% on out-of-network claims.
We love our partners.
We want to make sure your self-funded solution fits your needs. We’re integrated with several PBMs and networks. And we’ve carefully curated a set of point solution partners who meet our rigorous security and service standards. With proper lead time, we can even integrate with other solution partners if you have favorites.
Self-funded health benefits made better.
Our solution is built around the three core components of an innovative self-funded health plan—administrative services, clinical care management and cost management. Our offerings allow employers and advisors to optimize their benefits plans to drive better health outcomes at a lower cost.
We offer support and guidance on behalf of employers. Focus on the people and the business—we’ve got the rest.
- Plan, claims & eligibility management
- Member education & support
- Web portal & mobile app
- Analytics & reporting
Clinical Care Management
Costs decrease when employees are healthier. That’s why we focus on helping people be healthier before something goes wrong.
- Overall wellbeing
- Utilization review & pre-certification
- Chronic & complex condition management
- Acute case management