Building Blocks to Help Healthcare Payers Thrive in Our New Normal

Predicting costs, managing a change in claim volume, operating with fewer resources — healthcare payers are facing an environment filled with uncertainty. With so many “unknowns,” many payers need to shift priorities and redefine goals.

But how does a payer adapt to a still undefined new normal?

At MultiPlan, we know there’s no easy answer. Each organization has unique needs, and their cost management strategy should reflect this. That’s why we offer services that we can customize and arrange for each client. These are the building blocks for solid, yet flexible solutions that help healthcare payers thrive — even in uncertain times.

Network-Based Services: Solid Relationships and Customized Solutions

Strong provider relationships are at the foundation of MultiPlan’s network. We directly contract with more than 99% of the one million providers in our network. We’re always mindful of these healthcare professionals and facilities.

Payers also have the flexibility to structure their own networks to fit a changing healthcare environment. We can help them:

  • Do a complete build.
  • Expand into a new service area.
  • Fill location or specialty gaps.

Analytics-Based Services: Data Guided and Provider Accepted

Economic uncertainty may force many healthcare payers to re-evaluate their out-of-network cost containment solutions. With many providers being stretched to their limits, a payer’s strategy shouldn’t result in provider abrasion.

Taking cues from data, MultiPlan helps payers strike a balance between healthcare savings and member satisfaction, while preserving provider relationships. Payers have the flexibility to arrange or combine services, such as:

  • Cost-based pricing: Delivers fair, consistent and transparent pricing of hospital and other facility claims—with wide provider acceptance.
  • Negotiated agreements: Uses sophisticated financial benchmarks to drive agreements that offer members more protection from balance billing.
  • Other pricing methodologies: Offers time-honored methodologies for reducing out-of-network facility costs.

Payment Integrity Services: Automation and Expertise

With changes in claim volume, new codes and unfamiliar claim scenarios, payers may start seeing an upswing in billing issues. It can be challenging to stay on top of these issues, especially if payers are also facing staff reductions. MultiPlan can help keep proper payments on track. We go way beyond static automated approaches. Our rich databases and clinical experts combine to identify complex issues before payment.

We are always evolving. Our analytical programs have more than 300 million code combinations and are continuously refined. Plus, our doctors, clinicians and coders offer accelerated reviews when appropriate. This combination of technology and the human touch can better tackle unique situations related to the COVID-19 outbreak.

Because we take a pre-payment approach, we can help a payer identify unusual billing patterns or complex issues before payment. Addressing issues before payment can translate into savings as payers begin to see an increase in claims.

KH037 5/20/20

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