Commercial Payer Services
Navigant Consulting’s Commercial Payer practice focuses on providing sustainable solutions to clients by offering a comprehensive suite of services. We assist clients with operating model strategies, claims accuracy, provider reimbursement, changes in Medicare, regulatory requirements and large technology initiative assessments.
Our Commercial Payer practice maintains an expert-based team, focused on offering industry experienced resources with:
- Key knowledge and understanding of business process transformation, including managed care specific models
- Relevant experience designing and leading large scale business and technical transformation
- Resource knowledge of not only project and program management tools and techniques, but also first hand experience integrating large initiative requirements with implementation activities
- Former healthcare industry executives, clinicians and information technology subject matter experts
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Commercial Payer Services
Consulting Services for Commercial Payers
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Recent NCI Engagements for Commercial Payers
Commercial payer qualifications
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Services
Our core competencies include:
Claims Accuracy
We have identified key drivers responsible for overpayment, the impact on medical cost, and potential remedies to implement – which immediately and positively impact our clients’ competitive position.
Provider Reimbursement
The shift to consumer-directed healthcare is straining the relationship between providers and health plans. We help health plans design products that keep providers interested in maintaining and even strengthening their relationships.
Changes in Medicare
We help health plans understand the impact of Medicare’s changes and the corresponding policy and operational decisions that will need to be made.
Regulatory Requirements
Changing regulatory requirements have required business rule, process and system changes. Navigant Consulting helps to implement these changes and to operationalize ongoing measures to ensure compliance.
Large Technology Initiative Assessments
Software technology is the number one capital investment of health plans. Managing such investments is critical. To that end, we provide services in the areas of business enablement through technology, project governance strategies and financial oversight.
