CLAIMS OVERPAYMENT & RECOVERY

Savings Example: 10,000 Members

Estimated Annual Spend = $50,000,000

Estimated TOTAL Overpayment = $3,500,000

Estimated Recovered Overpayments

@ 2% Recovered = $1,000,000

@ 4% Recovered = $2,000,000

Average timeline for completion of the full audit and recovery process is between 6-9 months with funds starting to be returned as early as 45-60 days post implementation.

“Due to various infrastructure and

resource limitations, continued increases

in the complexities of adjudicating an

paying claims, eligibility process

concerns, we were pretty sure that we

had experienced some significant

overpayments through our TPA. When

Relevant knocked on our door and

provided such an aggressive and

resource free solution, we felt compelled

to move forward! And we are glad we

did! CFO, Midwest Based Employer

For more information on our Claims Overpayment & Recovery program or the many oth-er cost containment solutions offered by Relevant Healthcare, please contact us at:

WWW.RELEVANTHEALTHCARE.COM 855-328-5100

Recovery

On average, health plans overpay

7% or more on an annual basis.

A recent analysis of Medicare

claims puts the figure at 13% for

2014.

Recent and continued changes

within the US Healthcare system

(ACA, more complex coding rules

and regulations, etc.) is only

adding to the problem

“Recovery of Funds & Process Improvement”

Advantages of an Overpayment Recovery Project

Recover, on average 2-4% of the Plan’s total annual spend.

No need to expend resources—RHCC will audit, analyze

and re-adjudicate the claims data, identify the

overpayments, and actively recover those funds on behalf

of the client.

Such an audit is a direct step in showing that all legal

obligations of the plan sponsor have been met.

Our post audit follow up and collection activities ‘train’ our

clients for more effective claims adjudication in the future.

What Makes Relevant’s Recovery Solution Different?

Relevant offers a number of models for clients to choose from that best fit each individual organization’s needs: Flat Fee + Contingency, Full Contingency, 100% Fee Based (upfront, hourly, etc.), and an innovative Bid Strategy for clients who need funds immediately.

Our solution is a COMPLETE solution—Planning/Customization, Data Intake/Verification, Analysis/Audit Execution, Au-dit Reporting and Full Recovery services that deliver recovered funds directly to the client.

Our Post Audit Follow Up and Collection activities have analysts continuing to monitor claim payments and recover-ies, reviewing payer collection efforts, and challenging case closures, where warranted. This results in Process Im-provements and a more effective and efficient adjudication process for the client on a go forward basis.