Who Should Use This Service
For companies who are unable to implement our audit services pre-pay or do not have offset capabilities, Recovery is offered as a post-pay service. In some instances, HealthMind also sends the initial communication to the provider detailing the overpayment even when the client performs offsets. In addition, HealthMind can provide supplemental data mining when data or system constraints preclude a pre-pay deployment.
HealthMind’s Recovery & Data Mining services operate on the ReThink platform, which includes a robust workflow and reporting module. As such, the services are deployable to a large array of health plan offerings, including At-risk Commercial, Medicare Advantage, Medicaid Managed Care and state Medicaid plans, as well as Third Party Administrators. While these services can be implemented independently, they are intended to integrate with and augment our pre-pay services.
Process for Evaluation of Client’s Claim
HealthMind will evaluate a minimum six-month period of paid claims data to assess the potential savings from each of the audit modules relevant to your company’s lines of business. During this process, HealthMind will work with your company to validate the completeness and integrity of the data with respect to the requirements of the audit services, with particular attention to the data regarding contract specificity. A high-level assessment of your company’s payment policies and contracts will be conducted to ascertain what exclusions or customizations, if any, need to be put in place prior to deployment. HealthMind will collaborate with your company to determine best strategies for integrating data mining results into your offset process when possible, in order to reduce cost, and to promote efficient mechanisms and transparency for your providers.
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