PayerFusion empowers clients with access to the entire cycle of policy and claim administration and enables decisions free from afterthought.
Our process achieves claim integrity and bill reductions like no other in the U.S.
We utilize a technology-based system coupled with our unique sophisticated methodologies to provide you with the sharpest advantage possible. Our rules-driven tools enable you to remain competitive and compliant in an environment of ever-increasing costs and regulations.
Today’s U.S. healthcare system is fraught with inefficiencies and fraud.
Inflated and fraudulent bills result in $250 billion in unrecovered over payments each year. These over payments are calculated after supposed “discounts” have been applied to retail rates on provider bills. The results of such practices are needlessly high per claim costs, which are detrimental to the system as a whole.
As regulation in the U.S. increases providers are rapidly becoming less willing to agree to blanket or routine discounts – traditional methods of claims handling can no longer deliver acceptable results. This is when PayerFusion can help.
PayerFusion approaches in healthcare industry in a manner that aims to “fuse” the gap between payers and providers by creating win-win situations in benefits and claims administration – including claims pricing.
Providers deserve a fair profit based on cost, and payers need more than “discounts” – they need a true cost plus approach to price, which lowers the total amount they pay for healthcare claims beyond the PPO discount. PayerFusion employs the latest technology to give you control of your claims and truly reduces your costs and loss ratios. Cost per claim and policy performance are not forgotten, our process provides excellent reporting capabilities.