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 without push-back.

Key Services:

  • Claim Review - Electronic Analysis of your Claims Feed to search for large complex cases

  • Mining pre-certification and case management reports to identify large claims

  • Ensure accuracy and organization of repriced claims including the removal of billing errors prior to submission for payment.

  • Pre-Service Negotiations

  • Single Case Agreements

Types of Cases That We Can Impact:

  • Transplants

  • CAR T-Cell Therapy

  • Chemotherapy

  • Stem Cell Transplants

  • VAD implant and maintenance

  • Hemophilia-Factor Replacement Therapy

  • Dialysis

  • Cancer / Oncology

  • Congenital Heart Defects

  • Preemies or NICU babies

  • Large In-Network and Out-Of-Network claims

  • Infusions for High-Cost Drugs

Allowing HPC to shop our extensive network of specialty network contracts will ensure that you have the best solution in place with minimal effort because we do all the “heavy lifting” for you. The HPC team of experts will “mine” your precert, case management and other reports to find high-risk claimants. Then, we will scour our extensive list of specialty network contracts to find the best case rate or per-diem contract for that claimant.