Our healthcare claims negotiations are derived from what Medicare would reimburse for services rendered – not charges that have been billed by the healthcare provider. Securing 100% provider sign-off for every claim helps maximize workflow, eliminate dissatisfaction, and get rid of patient balance-billing.
All of our claims are filtered into the Consilium Decision Engine software through a hierarchy of triggers. These triggers are based on data from the claim, including provider geography and specialty, Medicare reimbursement, geographic usual & customary reimbursement, our history of negotiating with the provider, and more.
On average through using this software we are able to achieve 35% to 45% of savings on out of network claims in as little as three to five days.