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| IIS prefers the use of the following vendors. Our experience has shown that these service providers consistently demonstrate what IIS considers the "Best in Class" characteristics. | |
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American Health Holding, Inc. is a national medical management firm offering comprehensive services spanning the healthcare continuum.
Benefit Value: IIS has access to American Health’s i-Suite which gives us a direct real-time link to utilization review services such as admission notifications, length of stay approvals, clinical notes, and large case management notes plus an array of reports that can keep us informed about situations that may impact losses before they are submitted as claims. This in turn will help us provide a more realistic means of setting lasers and establishing renewal rates. We feel this service is worthy of an additional discount on the specific premium when pricing new business, and we therefore encourage the use of American Health as your utilization review provider. |
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Asert Benefit Services is a medical cost management company, specializing in medical bill evaluation and auditing, in-network bill review and correction to maximize PPO discounts, negotiated savings for out-of-network bills, and providing superior national and international network discounts. Benefit Value: IIS has observed thousands of dollars in claims cost savings by having Asert review hospital bills prior to reimbursement. In most cases, Asert can determine whether they can generate relative savings by conducting a pre-review of the bill. If authorized, the bill review is efficient and timely and monitored so that valuable PPO discounts are not forfeited. We have found that most hospitals bills over $25,000 have billing, treatment, or procedure errors that justify examination and inquiry. |
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Benefit Informatics, Inc. enables the efficient planning, management and analysis of employee benefit plans through proprietary online applications and services to Third Party Administrators, insurance companies, reinsurers, brokers and employers. Web-based capabilities include employee self-service benefit management, benchmarking of benefit plan performance, analysis of healthcare utilization patterns and modeling of benefit plan design alternatives. Through its clients, Benefit Informatics serves more than 3,500 businesses, managing health benefits for more than 2 million members. Benefit Value: IIS was the first MGU to utilize Benefit Informatics' RePorter product which provides a robust reporting tool that is linked to the mapped claims data of Benefit Informatics' TPA clients. RePorter gives IIS the ability to analyze this data on our clients either by case, TPA, or our entire block. We also feed this data into the predictive modeling software, MEDai, via an interface through Benefit Informatics. We find Benefit Informatics to be a valuable resource for TPAs looking to improve reporting, analytics, and MGU/carrier dialogue on case-specific data. |
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URN's Transplant Resource Services is the nation's leader in transplant management. U.R.N. has built a network comprised of facilities that have proven to be the "best of the best" in organ transplants in the country. This network of health care providers is called Transplant Centers of Excellence Network. By evaluating and contracting with these facilities, U.R.N. has been able to negotiate the best case rates on pre-transplant, transplant and post transplant care. Benefit Value: In most situations involving transplants, IIS utilizes Transplant Resource Services because in our opinion they have the superior network, discounts and evaluation process. Our clients have not only saved money by using TRS, they have also had patient outcomes that surpassed expectations. |
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URN's Fully Insured Managed Transplant Program provides solutions for Transplant costs that can be extremely unpredictable. The cost for an average transplant episode is $380,000, but depending on the circumstances, can rise to more than $ 1 million. United Resource Networks manages the clinical and financial aspects of transplant cases through the MTP, a fully insured transplant "carve out" product. The MTP provides access to the nation's leading Centers of Excellence transplant facilities. Benefit Value: Transplants are now accounting for a significant amount of claims and subsequent lasers in the excess loss and stop loss market. IIS feels that these claims can be handled best with the Managed Transplant program on a fully insured basis. After reviewing all plans offering this service, we prefer URN because they had the superior policy, network, and experience to provide an affordable solution. IIS will discount the specific rates based on the size of the deductible which in most cases offsets most or the entire MTP premium. |
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URN's EnvisionCare provides creative strategies for the management of patients with complex medical conditions. EnvisionCare emphasizes collaboration, empowerment, appropriate care, quality assurance, optimized outcomes and economic value in the care of individuals. Benefit Value: This service is similar to case management but it reaches beyond patient status and outcome to provide an essential tool in establishing the financial thresholds for providing quality patient care. In most cases, patient care is actually improved while costs are lowered. EnvisionCare also provides an outside resource in projected future claim costs and establishing parameters for lasers. IIS suggests the use of EnvisionCare in all claim situations exceeding $50,000 of the Specific deductible or resulting in or likely to result in hospital stays in excess of 10 days. |