Customized solutions for commercial healthcare payers

Helping healthcare payers and their plan members strike the ideal balance between service quality and cost

By the numbers

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Over 700 healthcare clients

Representing thousands of insured and self-insured groups

Nearly $27 billion in-network claims repriced annually

Annual reductions across all commercial network services

Nearly $15 billion in out-of-network claims reduced annually

Annual reduction across all commercial non-network services

Nearly $3 billion in payment integrity reductions annually

Annual reductions across all payment integrity services

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Our services in action

Customize a solution to solve any healthcare cost management problem
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Choose and arrange from the industry’s richest set of services designed to reduce medical spend before you pay.

Payment Integrity – What We Find

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Complex issues (60%)

Many findings need physician and/or code review to confirm:

  • Unlikely procedure combinations
  • Overlapping procedures
  • Contradictory procedure combinations
Suspect scenarios (10%)

Needs physician review and may require more documentation:

  • Potentially excessive services
  • Unusual services reported
  • Provider profiling (e.g., physical therapist reports the same services on every bill)
Simple issues (30%)

Generally found by claim editing software, but often overlooked:

  • Units above maximum likely levels
  • Inappropriate use of modifiers
  • Multiple procedure discounts
  • Unbundling

Defensible and effective pricing

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Whether using networks or not, it’s always better for a plan and its members to work in tandem with providers, and not against them, to manage medical spend. For pricing of non-contracted claims, MultiPlan’s Data iSight and Viant services offer defensible methodologies, integrated provider inquiry and resolution management, and a unique patient communication program designed to deliver support when balance billing does occur.

 

Learn more about why Data iSight has over 90% provider acceptance.

Our commercial healthcare networks

Network Hospitals

4,800 primary & 5,000 complementary

Ancillary Care Facilities

94,000 primary &113,000 complementary

Network Practitioners

797,000 primary & 836,000 complementary

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Case Study: Retaining important business

MultiPlan analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by:
significantly improving savings for the employer and its members; engaging important providers in the new process; and preserving the community’s provider-patient relationships.

Read more >
Female and two males looking at paper and laptop

Case Study: Retaining important business

MultiPlan analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by:
significantly improving savings for the employer and its members; engaging important providers in the new process; and preserving the community’s provider-patient relationships.

Read more >

Contact us

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Improve competitiveness and reduce medical spend. Use MultiPlan’s payment integrity and cost management services to customize solutions for you and your clients.