Medical Cost Management
Working Hard to Keep Your Costs Down and Your Members Happy.
Managing Health Care Costs
One of the biggest challenges facing employers today is how to provide affordable health care for their population. Our commitment to you is to provide innovative approaches to manage your medical costs. We believe that the biggest part of our job is saving you money - pure and simple. Through our knowledgeable, qualified staff and our well-organized, streamlined administration, we produce greater savings for all our clients.
Provider
Contracting
Referenced-Based
Pricing
Utilization
Review
Case
Management
Maternity
Management
Chronic Care
Management
Subrogation/Recovery Services
Claims
Editing
Medical Bill
Review
Dialysis
Management
Surgical Management Program
Wellness
Direct Provider Contracting – Our Provider Partners
HSG continuously finds ways to "watch your back". On behalf of our clients, we have negotiated with a number of hospitals and health care providers across the region to provide you with transparent and deeply discounted pricing. We have worked hard to build a network of facilities and providers that we call our Provider Partners. By implementing our services, you are able to tap into a trusted and proven network of professional facilities and providers and realize additional savings when compared to traditional PPO networks.
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Referenced-Based Reimbursement
It’s no mystery; there are huge variations for the identical health care services. Though prices vary, higher rates do not necessarily correspond to superior quality of care. Through Referenced-Based Pricing (RBP), all facilities will be paid the same for each specific procedure. That means that patients can search for the best facility to treat their condition, without regard to cost. With RBP, reimbursement is set at a rate that is considered a fair market value for the services rendered. The result is substantial savings when compared to traditional PPO network discounts.
Utilization Review/Management
You can be assured that your members will receive appropriate care when it is needed. Our experienced medical staff is with you throughout the process. We evaluate the appropriateness, necessity, and efficiency of the use of these health care services. We work closely with the patients and their providers to ensure that the care received is "best in class" and that it is reasonable in cost.
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Case Management
We believe that case management is a cooperative process of valuation, preparation, facilitation, and careful coordination. Our highly qualified medical staff work with patients and their families to help them understand their course of treatment. They also help them understand their benefits, and steer them to network providers to help control costs. Through our evaluation process, we ensure that treatment is medically necessary and meets standards of care.
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A healthy pregnancy will usually result in a healthy baby. Our maternity support program is tailored to identify high-risk pregnancy and help the expectant mother reduce the risk for pre-term delivery. Our qualified Registered Nurses will work one-on-one with the patient and and provide an individualized management plan to ensure a full-term healthy pregnancy.
Maternity Management
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Chronic Care Management
Living with a chronic condition can be overwhelming. We understand the importance for the patients to understand their condition and their treatment. By creating new procedures, we work hard to provide better service to people with chronic illness. We provide both transparency and coordination for those who suffer from chronic illness in order to offer better care for their needs.
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Subrogation Recovery Services
Subrogation is an important component of your health insurance plan. The subrogation process allows us to recover cost of claims your plan has paid, when in fact the claims were caused by another party. In this instance, we would request reimbursement of the claims from the responsible party. The subrogation process is complicated and involved, that is why we have developed a strategic partnership with The Phia Group, With careful coordination with The Phia Group, we provide a seamless process of insurance reimbursement. This way, you can rely on us to promptly, legally and professionally process claims through a tightly regulated procedure.
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Claims Editing
Accurate claims payment is our ultimate goal. We constantly review claims for errors and omissions. Our intuitive systems have been put in place in order to ensure that all medical claims are processed correctly the first time. By verifying that all claims are correct, we provide more cost-effective claims solutions.
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Medical Bill Review
Our medical bill review process will save you every possible dollar without compromising patient care. Our highly qualified vendor partners will audit your bills to ensure maximum savings and ensure proper payment for services received.
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Dialysis Management Services
There is no question – dialysis claims are expensive. Through our research and expertise, we have developed a dialysis program that will provide significant savings to your plan, without compromising patient care. We work very closely with the dialysis providers to negotiate fair reimbursement for their services and assist the patient throughout the process.
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Surgical Management Program
HSG’s commitment to you is to create innovative approaches to providing “best in class” health care and save you money while doing it. Through Provider Partners, we have contracted with a select group of providers who have accepted Medicare based reimbursement resulting in deep discounts. What this means to you is savings of up to 75% of billed charge. For employers who participate in this program, their plan participants can access these facilities and receive services with little or no out of pocket costs. Our Surgical Management Representative will work with your members to coordinate their care and help you and the member save money in the process.
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Wellness
We all know that poor health results in higher costs, and that most health care costs can be attributed to lifestyle. Our goal is to help you wrap your arms around these concerns by introducing wellness initiative plans that will improve your bottom line and the overall health of your population. We will work with you in partnership with Care ATC to assess your wellness needs and design a plan that will meet your goals.
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©2016 Healthcare Solutions Group 800 749 1422 | 325 N. Main Street | P.O. Box 1309, 74402 | Muskogee, OK 74401
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