Health Payer Consortium Health Payer Consortium

SERVICES

Case Management / UR

HPC’s Medical Case Management service focuses on active care coordination designed to improve patient outcomes and patient satisfaction while maximizing cost containment and financial oversight. BENEFITS FOR PATIENTS Benefit review & same-day turnaround for most precertification requests Coordination of health care services along the care continuum Continuity for patients experiencing catastrophic and chronic illnesses Coordination…

Reference-Based Pricing

Our reference-based pricing solution is completely automated and offers plan flexibility. Every year, reference based pricing becomes more and more accepted by providers in every state. Out of Network only, OON and Facility, or Complete RBP solution (including professional claims) Medicare rates on mature solution Multiple “flavors” of RBP to fit your groups and structure…

Out of Network Services

Our experienced negotiation team utilizes numerous tactics to reduce the cost of each claim. If a reasonable price for the reviewed service is not attainable through negotiation, we escalate the claim to a compliance audit. Our ultimate goal is to “train” your providers to charge the right price the first time. Every negotiated discount is…

Editing

Our editing product utilizes advanced clinical editing technology to ensure that both institutional and professional claims are properly coded and compliant with applicable payer requirements. Cloud Based EDI, Desktop Apps, SaaS or Web Service Delivery EDI in almost any Format (837,Excel, Access, Proprietary Text, etc.) Rules and Logic Updated Weekly* Customizable by Group, Provider, Codes…

HPC Advantage

The best clinical and financial outcome for both you and your members. The HPC Advantage program identifies high risk claims and matches them with a specialty network contract or other savings methodology provided by centers of excellence or other high-quality providers.  The result is an improved outcome for the patient, the provider, and the plan…

Medical Bill Review

We average a 15% reduction from annual billed charges by removing invalid and non-compliant charges prior to the application of a network contract. Our review is performed by clinicians and coding experts with advanced certifications and degrees. We identify errors and non-compliant charges per federal, state and commercially accepted billing guidelines. We review claims for…

ART OF LIVING BUILDING
  • 1141 South 7th Street, St. Louis MO 63104
  • TOLL FREE (844) 888-1HPC (1472)
  • (727) 216-1674 (HIPAA Secure)
  • healthpayerconsortium.com
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