Session Takeaways:
1. The OON pricing problem is bigger than most plans realize
Out-of-network claims carry disproportionate financial risk and most health plans are still relying on retrospective processes to catch what should have been stopped before payment. Oscar will share what they found when they looked hard at their own exposure.
Out-of-network claims carry disproportionate financial risk and most health plans are still relying on retrospective processes to catch what should have been stopped before payment. Oscar will share what they found when they looked hard at their own exposure.
2. Pricing alone isn't enough, payment integrity has to be part of the package
Repricing an OON claim gets you part of the way there. But without payment integrity embedded in the same process, plans are leaving significant savings on the table. We will share how integrating PI into OON workflow changes what is captured.
Repricing an OON claim gets you part of the way there. But without payment integrity embedded in the same process, plans are leaving significant savings on the table. We will share how integrating PI into OON workflow changes what is captured.
3. Speed and accuracy are not a tradeoff
A common concern among payers is that more rigorous pre-payment review slows claims processing.
A common concern among payers is that more rigorous pre-payment review slows claims processing.
4. What good partnership actually looks like in practice
Not all payment integrity vendors operate the same way. Oscar will speak candidly about what they needed from a partner, what ClaimInsight delivered, and what other plans should be asking for when they evaluate their options.
In partnership with AMPS
Not all payment integrity vendors operate the same way. Oscar will speak candidly about what they needed from a partner, what ClaimInsight delivered, and what other plans should be asking for when they evaluate their options.
In partnership with AMPS
Speaker(s):
Mark Noel
SVP, GM ClaimInsight
Advanced Medical Pricing Solutions
Rob Verrengia
Senior Vice President , Insurance Operations
Oscar Health
Time:
12:40pm
Session Type:
General Session (Presentation)
Force Inline Description:
0