Cost Containment Solutions
Additional Information
Risk management in healthcare involves the on-going utilization of clinical and administrative systems to identify, examine, prevent and mitigate risks and costs. It is a diverse field in an ever-evolving health care industry. In order to provide the most comprehensive reviews to our policyholders, KRMA has developed a team of clinical nurses, multi-line underwriters and specialty vendors who work together to assess health plan documents, examine claims, recognize savings on plans’ health spend, and advocate for member’s care.
KRMA is committed to developing our clients into informed payers of their health plans. KRMA and our partner vendors can help policyholders and prospective clients first by listening, and then by working together to design innovative solutions and achieve maximum savings potential. We offer:
- Pre-Claim plan document reviews to identify potential gaps in coverage and recommend tweaks to optimize employee benefits
- Ensuring that claims meet definitions of eligibility as established by the plan sponsor in the Health Plan Document
- Medical bill reviews and line by line audits to identify potential billing errors
- Leveraging current preferred contracts and negotiate rates
- Out-of-Network negotiations using reasonable and customary rates and historical experience
- Specialty prescription and home infusion service contracts from single case solutions to comprehensive support
- Data Analytics and predictive forecasting to identify cost drivers and influence member health outcomes
- Access to specialized analysis and rating of Reference Based Pricing and Proprietary Networks