Group Insurance Claims

Most claims are now processed with some type of PPO discount being applied to the hospital's chargemaster prices. On the out-of-network claims, Third Party Administrator's (TPA's) or insurance companies attempt to get some type of discount. Some companies are even taking discounts for out of network claims with the expectation that the provider will process the payment and never recognize that an unacceptable discount was taken. They then attempt to apply a PPO discount for claims that would not normally qualify. This practice has a risk or liability that may come back to the payer in the future demanding the balance of the claim be paid

Our software solution has been designed to review the comparable discount on an overall basis, or analyze the price increases on a departmental basis. In the past, hospitals have utilized sophisticated software programs to strategically implement chargemaster price increases.

.Out of Network Claims

TellLink Health negotiates with the providers and receive a signed binding agreement on the amount of payment and the discount that will be accepted. TellLink Health process all claims through our proprietary re-pricing software, utilizing all of the benchmarks that are developed for that claim to negotiate an equitable discount for both the payer and the provider.

PPO Discounts

If the claim is included as part of a PPO contract, we feel the payer is required to honor that contract and accept the discount stated in the contract. We also strongly believe that any payer with a PPO contract needs to review the appropriateness of the current discount they are receiving.

TellLink Health has developed a program that shows which hospitals have been the most aggressive in establishing and increasing their chargemaster prices, and which departments in those hospitals have had the highest price increases.

Actual example: If you had a 20 % PPO discount with hospital “X” in 1997, our data shows that a 70% PPO discount would be needed in 2007 to keep up with the hospital's price increases. The 70% discount has built in a 6% cost increase as reported by the hospital. 

Our software solution has been designed to review the comparable discount on an overall basis, or analyze the price increases on a departmental basis. In the past, hospitals have utilized sophisticated software programs to strategically implement chargemaster price increases. Our solution has the capability of uncovering what departments the hospitals have concentrated their price increases. Our database contains data for every hospital in the country. Our business analytics solution can be specifically used to compare price increases for hospitals in a particular area, county or even the entire State.  Our analytics solution is a very useful tool giving you defendable and defensible analyzed data before you start the negotiation process with any provider.

Contact us today to learn more about TellLink Services.