Highlights of Our Medical Claims Management Service
- Claim Repricing
- Claim Processing & Adjudication
- Claim Analysis & Validation
- Customized Reporting
- Electronic Payment and Claims
- Multi-currency Claims Adjudication
- Episode Life Cycle Management
- Member Communication & Customer Service
- Prospective, Retrospective & Concurrent Review
Cost-Plus Methodology: Our effective, fair and transparent approach to medical claims pricing
Our unique approach to claims reimbursement creates significant savings for our client partners while allowing providers a fair reimbursement based on the actual costs of service. Our unique Cost-Plus Pricing Methodology assesses each claim compared to national data reported by federal agencies. Utilizing this data we are able to determine the actual cost of service, needs of the provider to offset losses from Medicare patients and the fair retail cost of the service provided.
Claims Management Technology
PayerFusion’s technology solutions are designed to seamlessly integrate with your business processes and support every facet of health plan administration We provide clients with online access for monitoring the entire claims cycle, a custom-branded online provider search, advanced call-center technology and a user-friendly mobile app.
Claim Analysis & Validation
Each claim is reviewed for billing discrepancies in the structure of the case, duplicate charges, and inaccurate coding. This is based on coding standards set forth by the AMA (American Medical Association) and CCI (Correct Coding Initiative).
PayFuseNet – Our Provider Network
PayFuseNet is our proprietary provider network that gives our clients access to maximum savings and high-quality healthcare providers. This exclusive provider network is fully compliant with US regulations and features a Zero-Balance Billing Guarantee. Our network has an established presence across the USA, Puerto Rico, the Caribbean, Latin America, Europe, Asia, New Zealand and South Africa. Networks in development include Egypt, Turkey, India and China.