Consilium employs a sophisticated benchmarking analytics process for claims negotiations that sees medical cost reductions higher than anywhere else in the industry.
A. Billed Charge
Out-of-network claims are typically highly inflated, causing medical costs to rise significantly.
B. Traditional Claims Negotiation
The traditional claim negotiation process starts at the billed charge. This "top-down" approach leaves less room for leveraging greater discounts, and typically yields minimal discounts of only 15 – 22% off of billed charges.
C. Claims Benchmarking Analytics
Unlike the traditional process, we have developed claims benchmarking analytics using our proprietary database of $40 billion in paid claims data.
First, we re-price to Medicare to set a recognized standard and then factor in what providers normally accept from national, regional and local payers. This creates a benchmarking band demonstrating fair market value for reimbursement.
D. Consilium Approach
With its team of certified medical coders, Consilium begins its claim negotiation at the benchmarks, which takes the focus off the billed charge and puts it where it belongs: on what you should be paying for services rendered. This smarter approach reduces and helps you control healthcare costs, and saves you money on out-of-network claims payments.