Fiscal Cost Containment Programs
Reference Based Pricing
Integrated with our Inpatient and Outpatient Precertification program, MedWatch will access pricing and provide the approximate dollar amount payable to providers at the time of pre-cert. This pre-service and pre-admission service allows providers to have prior knowledge of the reimbursement model and greatly diminishes disputes and balance billing. If there are questions or concerns by the provider, MedWatch works to reach an agreement and provide education based on the members Benefit Plan design.
In and Out of Network Claims Review
Maximum savings, deep discounts, and the capability of impacting the majority of Out-of- Network and Large In-Network claims.
- Out-of-Network claims repriced with savings averaging 54%
- In-Network savings average 21% above and beyond the PPO discounts
- Specialty Dialysis Negotiation program, capped rates, specialized Plan Language suggestions
- Medicare Plus Repricing
- Legal backing, support and defense of the claim for the life of the claim; Provider Sign-off as requested