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Our database compiles annualized reimbursement data from over 2.4 million healthcare claims nationally. Based on the average accepted reimbursement rates for health insurance, reported specific cost data and historical charge reports we can recommend discounts and negotiate with providers on behalf of our clients to reduce costs and increase our clients’ bottom line. Our Fair Market Pricing model is based on what the provider actually receives in reimbursement rather than what the provider charges.
We combine provider-specific benchmarks with geographic data to create a true and defensible “fair market price” for each service. Our data is sound and transparent based on our massive database of information.
We use many different benchmarks, including rates specific providers accepted previously, geographically-specific Medicare rates, state Worker’s Compensation rates, cost-to-charge ratios, Tricare reimbursement rates, hospital-reported financial data, National Correct Coding Initiatives Edits (NCCI), and more to establish Fair Market Pricing data.
Fair Market Pricing regularly yields customers discounts of 45-55% of billed charges compared to 10-15% with PPO Network discounts or UCR Re-Pricing methods.
The claims administrator provides us with a copy of the UB-04 or CMS 1500, 837 claims file, or proprietary file. With that, we run claims through our re-pricing engine and provide you with a detailed report to attach to your provider remittance. We also give you customized savings reports and appeal reports regularly.
All cost containment programs we offer are fully customizable to match your needs. Our reports, Explanation of Review (EOR) reports and other reports can also be tailored to your specifications and produced with your private label.
When we handle a provider inquiry or appeal on your behalf, we see the process through from start to finish. This includes defending and negotiating settlements and completing documents with the appropriate, required language for the jurisdiction, citing appropriate statutes governing the reasonableness of the determination, and providing customized reports to our client for every appeal settlement.
Reliant takes full responsibility for defending our payment recommendations any time providers contact us. We provide detailed explanations illustrating how the determination was created, and address each area of concern. We follow up with the provider to verify $0 balance on accounts and maintain Appeals Logs. If providers request additional payments, we contact clients regarding amounts allowed for negotiated settlements. If providers are unwilling to settle and proceed with balance billing the patient, we continue to defend our recommended payment and attempt to absolve the patient of responsibility for amounts over the allowed payment.
Reliant conducts focused reviews on every claim based on objective standards of Fair Market Value and the nationally accepted standards of medical billing coding. This provides higher savings over other methods of claim reviews. Our highly trained audit teams provide recommended payment amounts via the Explanation of Review (EOR) documents. Reliant handles all provider push back and disputes in order to minimize any effort by our clients, allowing them to focus on other areas of their business.
We submit detailed letters and EOR documents to providers explaining benchmarks, fee schedules and regulations we used to determine payment amounts and any overpayments.
Reliant handles all communications and negotiations with providers regarding claims appeals to minimize provider confusion and discontent.
We provide professional lien negotiation service to attorneys interested in saving their clients money on high-dollar catastrophic medical claims in personal injury cases. This allows attorneys to preserve settlement funds for their clients. Our negotiators use the Fair Market Price service combined with profound understanding of medical provider finances to achieve significant savings for client cases.
Our experts use their skills and thorough knowledge of State regulations to provide significant saving beyond State fee schedules. Employers can reduce Workers’ Compensation claims and gain control of Workers’ Compensation costs.
Through our process of retroactive recovery audits on bills that have already been paid, Reliant is able to use the Fair Market Pricing benchmarks method to recover funds that would otherwise be lost in the healthcare system. This is an ideal service for out-of-network health claims and Workers’ Compensation bills. To date, over $4.25 million dollars have been recovered, representing 27% additional savings for our customers.
Our recovery services fee is based on a percentage of dollars recouped during a retrospective audit, thus eliminating any financial risk to our clients for using this service.
The Reliant audit team performs a line-by-line analysis of all claims submitted for recovery using our Fair Market Pricing method to determine the appropriate reimbursement level.
Reliant handles the recovery process from start to finish in this process. We have the professional negotiations team with the experience and knowledge necessary to ensure timely recoupment.
Our Fair Market Pricing method gives clients discounts of 45-55% of billed charges versus 10-15% with UCR Re-Pricing or PPO (Wrap) Network discounts.
Reliant guarantees a turnaround time of 48 hours or less for every claim review.
We validate all DRG codes and follow all applicable client State regulations. We determine the Fair Market Price for clients in all states necessary, and ensure all coding edits are supported and clinically sound. We verify appropriate use of coding modifiers. Our recovery program is “turn key” and we pursue refunds on behalf of the Payer. Reliant guarantees state Workers’ Compensation Fee Schedule compliance where required.