Clinical Negotiation
Maximizing savings while minimizing or eliminating balance billing
MultiPlan’s Clinical Negotiation service is unlike other editing solutions because it blends a review of edits and reductions with a financial negotiation for provider acceptance. With the provider’s sign-off, healthcare payors can have peace of mind that neither they nor their members will be balance billed the difference between the original and reduced charges.
An Innovative Blend of Technology, Human Processes and Clinical Expertise
While provider sign-off is a major difference between ours and similar solutions, it’s not the only differentiator. Some vendors rely solely on technology. Not us. We blend human processes with technology to find and resolve issues that standard editing software misses. The technology includes the use of machine learning* to prioritize our inventory, proprietary actuarial analytics that empower us to score claims at the greatest risk for having billing issues, and a portal to make communication with providers more efficient. The human processes include licensed, board-certified physicians, nurses or medical coders reviewing suspect charges and confirming errors supplemented with a professional team of representatives who work with the provider community on securing provider sign-off. And we do all of this before our clients pay a dime so they don’t have to waste time chasing down inappropriate payments.
*Our artificial intelligence (“AI”)/machine learning processes do not use generative AI technologies.
Types of Errors Identified
Unlikely combination
of procedures
Unusual services
reported
Excessive services
reported over time
Numbers that Matter
41%
Average Success Rate
72%
Average Savings
33%
Finds Evidence of Waste and Abuse on Charges Scored
The Ways You Win with Clinical Negotiation
Drives savings by identifying inaccurate billing
Finds and resolves issues others miss
Removes potential for balance billing because providers sign off on our findings
Minimizes or eliminates pay and chase
Minimizes provider abrasion
Why MultiPlan Is Different
We're clinically focused
We involve clinicians at every step, including daily claim reviews and provider appeal support.
We go beyond automation
We integrate clinical review to confirm complex issues prior to recommendation.
We know pre-payment
Four decades of pre-pay experience - most claims returned within 24 hours.
We know providers
We contract with over 1.2 million practitioners and facilities; with an appeal rate of 3%, we minimize provider abrasion.
We know waste/abuse
With our long-tenured focus on non-contracted claims, we see the most creative billing schemes.
We're a trusted partner
We are HITRUST certified with nearly 300 payors depending on us for pre-payment integrity services.
Your Payment Accuracy Partner
Better payment accuracy means more affordable healthcare and a stronger provider-plan-patient relationship.
Prevent
Minimize future billing errors with explanations and education that improves the quality of provider billing
Correct
Detect and correct complex billing errors and suspect patterns normally only addressable in a post-payment review
Recover
Focus recovery efforts for more egregious overpayments by lessening the number of incorrect billing scenarios that make it through your pre-payment adjudication
Webpage last updated: 1/9/25