wHAT wE dO

Our core focus lies in providing claim integrity and specialty pharmacy solutions that recover overpaid medical claim payments and reduce the overall costs of medical and specialty pharmacy claims. These solutions are meticulously designed to enhance accuracy, streamline processes, and optimize financial outcomes for our clients. Whether recovering overpaid claim dollars, minimizing inaccurately paid claims, or improving efficiency in the benefit verification process, our expertise ensures that organizations can confidently navigate the complex landscape of healthcare claims.  Our commitment lies in helping you become a compliant fiduciary by ensuring the utmost accuracy in paying medical and pharmacy claims. Feel free to explore our comprehensive suite of services, tailored to meet employers, hospitals, healthcare systems, and payors’ unique needs.   

wHAT WE tHINK

The high cost of medical care in the United States is a significant challenge for US employers, impacting everything from profits to the economy and individual behavior. Several driving forces behind this issue include an aging population that leads to more chronic and costly conditions, primarily driven by poor overall health of the workforce.

An unhealthy workforce drives demand for more expensive healthcare services, which escalates costs. While beneficial, new medical technology, advanced treatments, and diagnostics come with a hefty price tag. Coupled with inflation and high administrative expenses, higher utilization of these newer and more costly medical technologies contributes to the escalation of costs for employers.

While we cannot do much to affect costs driven by demographics, increased utilization, new and expensive medical technology, poor health, inflation, and high administrative costs, we can impact two factors of increased healthcare cost without much disruption or abrasion to employers and their employees. These factors are specialty medication costs and fraud, waste, and abuse.

As an employer, you can reduce your annual healthcare costs by roughly 10-12% annually by addressing these two issues inside the health plan. With our help, you can take control of your healthcare costs and keep your business profitable while ensuring the health and well-being of your employees. Let’s work together to solve this challenge and make healthcare more affordable.

wHO WE SERVE

  • Employers
  • Hospitals
  • Government Entities
  • Payors
  • Healthcare Providers
  • Associations
  • Individuals