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Financial Recovery Systems
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The Issue
The U.S. health care system has evolved into a complex system where health care providers are entitled to reimbursement for services by primary, secondary, and even tertiary payers comprised of Government programs, commercial insurers, and patients. Coordinating reimbursement among these payers is a complex process that relies heavily on collection of accurate information about multiple coverages and diligent efforts to file primary and secondary claims with the appropriate parties, manage denials, and track reimbursements.
The Solution
Humana Military Financial Recovery Systems offer several reimbursement optimization services designed to help both payers and providers manage reimbursements for services rendered.
- Coordination of Benefits (COB) represents a significant challenge for all payers and providers—public and private. We help our customers develop, implement, and manage highly effective COB programs through timely and complete collection of patients’ insurance information, analytics to identify COB coordination opportunities, and a structured approach to claim submission, tracking, and resolution.
- Claim Audits represent one of the most effective ways of identifying overpayments, underpayments, other party liabilities, and adjudication errors. Our focused audits, DRG validation audits, and chart reviews ensure that reimbursement amounts are consistent with policies and supported by medical records. Using our sophisticated analytical tools we can quickly and efficiently review claims to ensure accurate pricing and identify possible adjudication errors prior to payment. When overpayments are identified, our trained and experienced recoupment specialists can help recoup monies owed.
- Denial Management is a necessity in the claim-based reimbursement model. Our Denial Management program helps customers minimize denials through process improvement. Recognizing that even the most efficient organizations experience some denials, we also offer administrative services and specialized tools to help prioritize, automate, and track resubmissions.
- Leverage state-of-the-art technologies that maximize inquiry handling efficiency and reduced transaction costs such as Integrated Voice Response, Automated Call Distribution, Voice over Internet Protocol, Call Recording, Document Imaging and Workflow, and Workforce Management Systems.
- Our flexible service delivery model can accommodate decentralized and centralized approaches depending on client priorities, preferences, and space availability.
- Our large contact centers offer customers access to economies of scale that can significantly reduce the operating costs of delivering high quality customer service.
Humana Military Financial Recovery Systems offer a variety of customized services to help optimize reimbursement and maximize collections from third parties. Our offerings combine implementation of best practices; sophisticated tools and analytics; and trained, experienced staff. Small Business Support
Through our strategic network of small business prime contractors and subcontractors, we can help Government agencies and contractors satisfy their small business contracting goals, meeting service-disabled veteran-owned, 8(a), HUBZone, Tribal Owned, and small disadvantaged business considerations.
For more information, contact:
Mr. Matt Biefeld
Director of Claims Oversight
502-301-6524 mbiefeld@humana.com
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