How we help you manage costs

  • Deep quality assurance

    Our Quality Assurance program is the product of years of experience and innovation. Our QA practices are designed to drive claims accuracy and quickly detect fraud and abuse.

  • Integrated utilization management

    Our Utilization Management team works closely with our Claims department to provide an unrivalled continuity of care. Services include utilization review, case management, wellness programs, and disease management.

  • Claims accuracy

    We are leaders in the industry for claims accuracy and turnaround. Our nurses routinely review claims for medical necessity and our QA department audits high-cost claims to identify savings opportunities.

  • Transparent analytics & insights

    Our solutions leverage the latest innovations to drive insights and produce real results. You’ll have access to our interactive HCNavigator report, benchmarking and predictive modeling tools, dashboards, and an extensive library of reports.

  • Dedicated stop-loss team

    Our Stop-Loss team uses proprietary software to identify claims that are eligible for reimbursement and monitor receivables from stop-loss carriers to groups. We also have in-house attorneys available to assist in appeals of denied reimbursement claims.

  • Multifaceted cost containment

    Our Cost Containment team uses a number of practices to capture savings. Services include fee negotiation, subrogation, eligibility auditing, stop-loss reporting, and coordination of benefits.

  • Plans & networks that work for you

    Our plan-building experts work closely with you to ensure that your health plan works with your bottom line. And with access to a broad range of provider networks, you can customize your plan to align with your company’s needs.

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