COST

CONTAINMENT

At One Team Health, we offer effective cost containment strategies to prevent unnecessary spending to help our clients intelligently  reduce expenses and improve profitability.

As a cost containment specialist, We understand Provider networks, encouraging redirection and utilizing Arbitration / Pre-negotiation tactics whenever the opportunity presents to assist with the cost containment goals of our clients.

​OTH specializes in and offers:

  • HMO access

  • High Dollar Claims Medical Reviews

  • Access to extensive Provider Networks in the US

  • High Dollar Claim Negotiation & Pre-negotiation

  • Claim Arbitration

  • Claim Adjudication & Bill Editing

NETWORK ACCESS
AND
COST CONTAINMENT

Through our access of extensive networks of US Healthcare providers, our proactive Case Management Professionals will promote cost containment whever possible, therefore, are always aware of the costs as they occur and the contract rates with the providers within the networks we access.

 

High dollar surgical cases, especially transplant cases are carefully evaluated as soon as OTH has been made aware, giving OTH the opportunity to redirect the member before any work-ups are done to the most cost effective facility based on their discounts, case rates and quality of care.

We provide:

  • Over 15 years of knowledge of the US Medical System

  • Access to a wide range of PPO networks and HMOs

  • A dedicated Provider Network Specialist who will assist with direct contracting and offer details on provider alternatives

HIGH DOLLAR CLAIM NEGOTIATION,

PRE-NEGOTIATION,

ARBITRATION,

AND

SETTLEMENTS

OTH understands that intervening early on in a case is the key to controlling its overall costs and offers the expertise of our Negotiation and Arbitration Specialists to secure Signed Agreements to Lock-in savings results for our clients to improve their bottom-line, especially for:

 

  • High Dollar Claims and Cases

  • Non-Participating Facilities and

  • Out of Network Claims

Should early intervention not be the reality, our experts will still Arbitrate Claims on the back end for recent and Outstanding, Unpaid and Dated Claims.

HIGH DOLLAR CLAIMS
MEDICAL REVIEWS

OTHs Team of Medical Professionals have over 18 years of practicing experience.  With their expertise, our clients have access to our veteran physicians and nurses who can, assess when medical treatments and services are accurate and appropriate, while a case is being managed or when claims have been received.

© 2020 by ONE TEAM HEALTH, INC.

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