All claims are not created equal, and a strategic approach to each claim is necessary to maximize out-of-network savings. At HRGi, we do this with skilled negotiators, continuous training and process improvements, and our own Claims Scoring and Valuation Engine, known as ClaimSAVEsm.
ClaimSAVEtm: How it works
- We extract the greatest possible discounts from claims by using a custom selection process to focus on claims with the greatest savings potential.
- Incoming claims are scored by billed amount, provider type, specialty, geographic location, claim attributes and provider history.
- Potential savings yield is projected for each claim.
Most traditional programs focus on high dollar thresholds for fee negotiation or rely on run-of-the-mill fax programs to approach providers. With ClaimSAVEtm, we can sort through claims to pinpoint those with the greatest savings potential and apply our time-honored negotiation strategies to smaller claims. This enables us to negotiate significant discounts on claims of all sizes.
Utilizing a proprietary algorithm, ClaimSAVEtm maximizes savings for clients through the optimization of a bundled fee negotiation and PPO network strategy. This approach consistently delivers the deepest overall savings in the industry without disruption to our clients and the providers.
Defining best practices for the industry
For over two decades, HRGi has been defining the practices needed to achieve the deepest discounts through the negotiation process. We recognize the importance of employing skilled negotiators and equipping them with the right techniques and tools — like ClaimSAVEtm. Our negotiators participate in ongoing training and quality performance audits to help them achieve successful results with every negotiation.