Healthcare Claims Negotiation Made Easy

Healthcare Claims Negotiation can be an arduous process, but it doesn’t have to be. Consilium will always attempt to negotiate first before a PPO discount is utilized. For each claim we receive, the Consilium Decision Engine helps determine how we can achieve the greatest discounts through analysis of industry reimbursement and comprehensive claim history. Our expert negotiators have built proprietary contracts and strategic partnerships with numerous providers to ensure fast and fair reimbursement. Consilium also has access to over 150 PPO networks, which can be utilized to achieve savings if we are unsuccessful in obtaining negotiations.

Claims Negotiation

Our healthcare claims negotiations are performed by certified medical coders using the Consilium proprietary software to establish Medicare reimbursement levels, usual and customary, code edits, and prevailing rates charged for specific procedures by providers to achieve best outcomes. Our negotiators obtain 100% provider sign off for every claim negotiated to eliminate patient balance billing.

Billed Charges Conversion to Percentage of Medicare Allowable

Through the Consilium Decision Engine all claims can be converted to a percentage of Medicare Allowable measurement to allow payors an accurate measurement of true cost.

Enhanced Bill Review

Our enhanced bill review services can provide complete medical savings solution for all of your in and out of network medical bills. This product is structure so that you can define and adjust line item charges on all medical bills to the appropriate market value, as provided under most insurance programs.

Prepayment Overpayment Protection

A fundamental partnership we have is with Armor overpayment protection service. This service allows us to identify and stop your medical claim overpayments before they become overpayments. It intercepts all submitted medical claims, identifies medical coding errors, and then transmits all of the errors found to the Third Party Administrator. The TPA then is able to deny the claim line in error, effectively stopping overcharges and reducing the overall cost.

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We are a leading preferred out of network claims negotiator providing our clients with intelligent healthcare technology, exceptional reporting performance, and the most competitive pricing that produces significant cost savings results.

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