CLAIMS

MANAGEMENT

With over 15 years collective expertise in handling medical claims, OTH has become a proven specialist in:

 

  • Complex Claims Management

  • Cost Containment using Medicare and Usual Customary and Rates

  • US and International Claims Review, Auditing and Adjudication

  • Claims negotiations and settlements

Guaranteeing full transparency, OTH has earned the complete trust of our clients by providing a responsive claims customer service experience that ensures all partners are well informed at all times.

COMPLEX
CLAIMS
MANAGEMENT

Our Well-Seasoned Claims Management Team consisting of Medical Professionals, Veteran Claims Adjudicators and Negotiation experts work synergistic-ally to:

  • Detect and prevent Fraud, Over-utilization and Unethical practices

  • Perform Medical Reviews that ensure all billing codes are appropriate and accurate

  • Secure  maximum savings using:

    • Direct negotiations with Providers from our wide network

    • Our Unique Relationships with Provider International /Business Offices

CLAIMS

ADMINISTRATION: REVIEW, AUDITING,

ADJUDICATION

Whether it is a straightforward, simple claim or the most highly complex medical claim, OTH guarantees swift and accurate processing and payment.

Our Claims Administration Team assures this by providing our Clients with services that include:

  • Timely Payment

  • Claims Adjudication & Bill Review/Editing

  • Expert handling of US and International Claims

  • Expedited & tailored resolutions to any escalated matter

  • A dedicated authority that assures Coding Modifier Fidelity, who works with and educates Providers on Billing Method best

  • An assigned Pre/Post Account Payment Reconciliation expert ensuring report and payment integrity

CLAIMS NEGOTIATIONS
AND
SETTLEMENTS

Regardless of the situation, OTH's Team of Negotiation experts always find a solution that secures superior savings for our Clients when compared to industry standards.   Our Team will:

  • Acquire Signed Agreements & Settlements that lock in savings

  • Work with our Clients to inform them of their options so they can make the final decision

  • Analyze bills and Utilize benchmarks such as Medicare+ and relevant cost data to ensure our performance compared to that of industry standards

  • Engage in direct negotiations with providers for high-dollar claims

© 2020 by ONE TEAM HEALTH, INC.

  • OTH LinkedIn