Claims Payment Reviews
In today’s turbulent economy and changing political landscape, there is at least one constant for any health insurer – the need to control costs. Many insurers are in the process of revisiting their provider agreements and payment rates. Insurers should also carefully assess whether they are paying claims accurately. Despite significant advancements in claims payment systems, Healthcare Payers continue to face enormous financial risk from claims payment errors.
While insurers strive for a claims payment financial accuracy rate of 99 percent or better, they are more likely to achieve between a 96% and 97.5% accuracy rate, leaving significant opportunities for improvement. Our current economy may drive purchasers, providers and insurers to focus increasingly on this margin of error: providers will be pressured to collect all payments due to them, while purchasers such as employers and government agencies will be increasingly pressured to make sure they are not overpaying for services.
Navigant’s Approach
Our approach to each project is unique and tailored to the business needs and environment of the client. We provide forensic-like insights to existing operational issues that impact the organization’s financials.
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Claims Payment Reviews
Claims payment review case studies and overview of services.
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Our management consultants are seasoned at identifying various types of claims payment errors, including:
- Duplicate claims or charges
- Ineligible members
- Services using the wrong fee or product schedule
- Unauthorized services
- Benefits or services not covered
- Incorrectly bundled or unbundled services or incorrectly coded services
- Services paid at out-of-network rates to an in-network provider
Why Navigant?
Navigant Consulting’s breadth and depth of experience make us uniquely qualified not only to identify claims payment problems, but to recommend solutions and to aid our clients in the implementation of those solutions.
Navigant Consulting has a proven methodology and tool kit for helping clients to uncover and quantify their claims payment errors and – most importantly – to identify the underlying causes of those errors and build a roadmap for improvement.
