Our Process

Health Decisions provides Post-Payment Administration. We start after everyone else is done.

Our services help recover 1-3% of paid claims. Our findings help management monitor performance progress and identify areas in need of attention. Paperless Case Review and collection can be outsourced or done by internal staff using our suite of software tools.

Health Decisions Process

How

  • CQI Goals / Status / Monitoring
  • Action Plan
  • Plan Execution
  • Consultant Management
  • HDI Technical Support

How Much

  • 1% of claims recovered
  • 5% of expected miss payments avoided
  • 4% of enrollment costs eliminated
  • Value of SOX Compliance
  • Value of Fiduciary Role

How

  • Identification - analyze 100% of paid claims in 40+ recovery areas
  • Investigation - validate and document recoverable claims/funds
  • Collection - assist the client in recovering monies due

How Much

  • Up to 10% in recovery potential
    • 2% expected
  • Re-ocurring and manageable

How

  • Surveys
  • Call Center
  • 3rd Party Sources
  • Government Sources

How Much

  • Up to 10% in missed COB
    • 2% expected
  • Up to 12% ineligibles
    • 4% expected
  • Re-ocurring and preventable

How

  • All sources mapped and linked
  • Data Quality / Data Adequacy
  • Microsoft and Web Compatible
  • Secure and Hippa compliant

How Much

  • Up to 5%
    • 1% expected
  • Usually Systematic and correctable

Claim Recovery Return on Investment

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409 Plymouth Road, Suite 220 • Plymouth, Michigan 48170
phone 734­.451.2230 • fax 734­.451.2835
© 2011 - 2017 Health Decisions, Inc.