Apr 2, 2024 | Case Studies, Claims, Claims Management, Claims negotiation, Cost Savings, Forensic claims review, Savings
Claim savings don’t have to end with the PPO network discount. With MedBen’s forensic claims review services, savings are produced after network discounts are applied, but before claims are paid. As the case study below shows, while PPO network discounts alone...
Nov 27, 2023 | Case Studies, Claims, Claims negotiation, Cost Savings, Forensic claims review
A MedBen client realized an overall savings of 62% through repricing, forensic claims review, and provider negotiation. The client in question received a claim for IV infusion to a member with iron deficiency. After the PPO discount, MedBen saw an opportunity to...
Sep 5, 2023 | Alternative Reimbursement Strategies, Claims, Comparative Effectiveness, Cost Savings, Direct-to-Employer Contracting, Drug costs, Fair Market Pricing, Forensic claims review, High-cost claims, Inflation, MedBen Rx, MedBen WellLiving, Reference-Based Pricing, Rx Costs, Savings, Self-funding, Specialty Care, Survey, Wellness
A new survey by International Foundation of Employee Benefit Plans found employers expect plan costs to increase seven percent in 2024. As to why, they gave a range of answers, with the top four reasons representing 71 percent of responses (see chart below). As it...
Aug 4, 2023 | Algorithms, Forensic claims review, Lawsuits, Self-funding
In claims progressing, algorithms – mathematical formulas used to scrutinize particular elements of a claim form – can be good when used to ensure the accuracy and consistency of claim payments… but bad when used as a tool to deny claims. In a class action...
May 16, 2023 | Alternative Reimbursement Strategies, Announcements, Case Studies, Client Report, Client Services, Client Surveys, Communication, Compliance, Cost Plus Pricing, Cost Savings, Direct-to-Employer Contracting, Drug costs, Forensic claims review, HealthJoy, Inflation, Kurt Harden, MedBen Rx, MedBen WellLiving, Member engagement, Mobile App, Online Services, Own Use, Pharmacy, Pharmacy Benefits Manager (PBM), Plan Design, Plan Language, Prescription, Reference-Based Pricing, Regulatory, Rx Costs, Savings, Self-funding, Specialty Drugs, Supreme Court, Wellness
The 2023 MedBen Client Report is now available to download from MedBen.com! In his opening note, MedBen President Kurt Harden states: “This Client Report is designed to demonstrate ways that clients can generate greater value from their health plan. With health...
Mar 31, 2023 | Claims, Claims Management, Direct-to-Employer Contracting, Forensic claims review, MedBen University, Medical necessity, Roundtables
Contracting directly with a health system offers employers pricing control, member access to high-quality local care, and the flexibility to create multiple benefit options. At this year’s MedBen University roundtables, Regional Sales Director Brooke Hupp...
