Primary PhysicianCare, Inc.  contracts with a client to perform case rate negotiation services for all scheduled surgeries, hospitalizations and diagnostic tests. As each medical encounter was pre-certified through the medical department, it was screened for potential case rate negotiation.  The following steps were completed for each case under review:

• Determine network status of provider
• Determine current contract discount level
• Analyze alternative treatments
• Analyze for alternative facilities/locations
• Engage provider in price negotiation
• Document negotiated price and pended claims

Healthgram® software aids in the process of negotiating charges with a medical provider or facility.  All specific encounters are negotiated before payment is made.  Review of the itemized bill, disclosure of the provider’s purchase order of supplies, etc. are reviewed as part of the negotiation process.  Once full transparency is achieved, a substantial discount is typically obtained.

Here are the top 5 cases that were negotiated during this study period:

Average Program Results:

61%   Savings

Procedures involving implants, such as back surgeries are among the fastest growing areas of medical cost inflation.   By comparing purchase orders to national cost databases, we are able to identify  overcharges and negotiate them down.

Case rate negotiation is part of our medical management process that sets us apart from larger insurance companies and other TPA’s.  Let us help you reduce the soaring cost trend of healthcare for you and your members by implementing Healthgram® software.