Direct Claims Negotiation
We act as an independent negotiator on behalf of health plans to reduce provider payments.
Why Direct Claims Negotiation Matters
Provider billing practices and fee structures are complex and ever-changing, reducing cost transparency and opportunities to identify provider payment flexibility.
Claims Negotiation Services by Healthalytica
Our approach is highly focused, data-driven, and built to integrate seamlessly with existing client workflows. Claims are negotiated using deep market knowledge, clinical expertise, and provider and reimbursement intelligence.
There for Every step of the Negotiations Process
Identify
Clients set the business rules on which types of claims are to be negotiated. These are usually any claim above a defined payable amount. Then, on a weekly or monthly basis, clients send us a claims file containing adjudicated claims in “ready to pay” status (but not yet paid).
Negotiate
We select and negotiate those claims, following the business rules in a manner which is complementary to existing client workflows.
Settle
When a negotiation is successful, a settlement is signed by the provider agreeing to accept the discounted charges. This information is then shared with the client in a secure, efficient manner to pay the reduced amount.
Greater Savings and Better Settlement Outcomes
Success
Almost 40% of claims priced at or above 125% of Medicare are successfully settled at a lesser amount.
Savings
Negotiated claims originally priced at or above 125% of Medicare are averaging savings of more than 30% below allowed charges.
Satisfaction
Negotiated claims are settled as payment in full – eliminating balance-billing to patients. This results in greater than 99% reduction in provider and patient complaints, appeals, and inquiries for settled claims.
Start Gaining Visibility and Greater Control Over Your Healthcare Spending
Discover how Healthalytica's highly effective claims negotiation services can help your organization reduce claims costs and strengthen your health plan's bottom-line.
FAQs
Learn more about how Healthalytica helps organizations gain greater control and reductions of their healthcare spending with Direct Claims Negotiations Services.
What do Direct Claims Negotiations Services Provide?
This simple concept delivers tremendous value based on decades of expertise and market intelligence. By providing us your claims before they're paid, we are able to contact and negotiate with billing providers to accept amounts which are lower than might have otherwise paid.
Who is Direct Claims Negotiations Services designed for?
Any organization responsible for the payment of healthcare benefits such as health plans, self-insured employers, insurance companies, and union benefit funds.
How is Healthalytica able to negotiate claims savings?
By leveraging historical industry billing data and experience, we are able to determine when a claim for healthcare services may have "hidden margin" which the provider may be willing to reduce. Not all claims or providers do, or can, but the success rates are large enough to make this a very successful program
What makes Healthalytica's Direct Claims Negotiation Services different from others?
Our team's background in the healthcare provider billing ecosystem, and our proprietary database containing market intelligence and billing trends over decades, enables us to perform at a level of success that our competitors can't. Whereas many competitors use "blanket" contracts for set rates across all types of claims, we invest the time and effort to maximize savings for each claim and each provider based on their unique characteristics.
