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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

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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:

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  • 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

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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.

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

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  • 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:

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  • 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

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