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Medical
MedCost Benefit Services fully understands an employer’s desire to make sure health care dollars are spent wisely. In addition to working with clients and brokers to recommend quality stop-loss carriers and contracts, we apply several cost management strategies to insure that your money is spent appropriately.
Claims Processing
We save money for our clients by providing efficient, accurate, and secure
claims processing. MedCost receives over
90% of its claims via Electronic
Data Interchange (EDI). This electronic exchange of claims data allows
us to process claims quickly and with 99.4% financial and 99% procedural
accuracy.
Our claim processing system provides online edits for coordination of benefits (COB), preexisting conditions, subrogation, and “rebundling” of claims. MedCost uses the leading clinical editing software available to review coding accuracy and appropriateness before claims move to adjudication, resulting in a reduction of overpayments or unnecessary payments to providers. These online edits result in considerable claim dollar savings for our clients.
Network
MedCost utilizes the MedCost
Preferred PPO network, which includes over
35,000 physicians, hospitals, and medical service facilities. Using
a PPO network allows members to choose their providers while still
offering substantial cost savings to employers. On average, we save
our clients $64.9
for every $1 they pay to access the network. To meet
the needs of our clients outside the Carolinas, MedCost also maintains
positive relationships with national, regional, and travel networks.
Provider Review
MedCost is fortunate to have a team focused exclusively on physician
billing and utilization practices. Led by one of the most respected
physicians in the region, this team profiles providers by specialty
to identify any who have unusual billing practices or abnormally high
utilization. MedCost studies this information to determine how a provider
compares to peer providers in the Carolinas. These reviews are part
of our quality initiatives and our long-term goal of having and maintaining
the highest-quality, most cost-effective network of providers.
Subrogation
MedCost manages all the details of
subrogation
Subrogation is a legal process a company uses to seek reimbursement from
liable third parties for a medical claim it has already paid. This
reimbursement could involve deductibles paid by members or costs paid
by an insurance plan. This action depends on the circumstances surrounding
the claim, the provisions in the health plan, and state laws.
Subrogation
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