Cost Plus Plan Components. Claim Process Claim Audit -Duplicate Charges -Medical Necessity Claim Re-pricing -Cost Plus 12% Margin or -Medicare + 20% _______________________________________.

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Presentation transcript:

Cost Plus Plan Components

Claim Process Claim Audit -Duplicate Charges -Medical Necessity Claim Re-pricing -Cost Plus 12% Margin or -Medicare + 20% _______________________________________ Frequency100% Cost? Appeals -Provider Files Appeal -Full & Fair Review By Independent Expert _________________________________________ Frequency7% Cost?

Liability Exposure Balance Billing Law firm inserted between patient and provider. ________________________________________ Frequency50% Cost? Lawsuits Insurance policy indemnifies the Plan, patient, TPA and broker/consultant ________________________________________ Frequency0% CostRetention & Premium

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