HEALTH PLANS
REDUCE THE COST OF COMPLIANCE
Incorrectly paid claims are costly. Engage can help reduce these costs through our suite of cost avoidance solutions that reduce payment errors and improve recoveries.
HEALTH PLANS
REDUCE THE COST OF COMPLIANCE
Incorrectly paid claims are costly. Engage can help reduce these costs through our suite of cost avoidance solutions that reduce payment errors and improve recoveries.
Engage Health
Innovative, Cost Avoidance Solutions
The Engage team has decades of program integrity experience working with the most well-known payers in the country. Our team has worked on three CMS Recovery Audit Contractor programs since the inception of the program. We have been engaged in millions of data mining, coding and medical necessity reviews across all types of audits, (e.g., inpatient, outpatient and post acute.) Engage has expertise in writing concepts, developing audit procedures and workflows as well as navigating the appeal process. With this one-of-a-kind experience at hand, the team at Engage has developed focused cost avoidance solutions that improve Program Integrity performance and, most importantly, reduce costs.
Utilizing the cost avoidance solutions by Engage, health plans and their internal Program Integrity teams can be empowered to better identify claims that are suspect of being inaccurate. Our technology and BPO solutions can be deployed in a pre-payment position to identify errors before they occur or in post-pay to confirm payment accuracy. The program integrity solutions help empower your internal program integrity team by promoting internal error identification using Engage’s proprietary technical systems and our BPO resources to act on the errors identified. Unlike most Program Integrity recovery programs, Engage is not motivated solely by error identification. Rather, our focus is payment accuracy and, most importantly, resolution of the cause of the error to avoid repetition in the future.
Cost Avoidance Solutions For Health Plans
SELF-SERVICE ANALYTICS
Our analytics program can be deployed as a full outsourced BPO solution or your internal team can build and implement sophisticated, dynamic error trapping algorithms to curb potential overpayments. Our AI driven, data analytical solutions can empower your Payment Integrity teams thereby lessening the the high cost of audit and recovery outsourcing.
REVIEW AND AUDITING
Engage can provide full outsourced BPO services or we can provide flex capabilities to augment your internal team. We have a full complement of clinicians, coders, validators, and reimbursement specialists for short or long-term projects. Control your recovery costs and ensure payment accuracy by partnering with Engage as a review resource.
CONSULTING
Engage has experience implementing and operating a variety of Payment Integrity initiatives. We know which programs are effective and which are not. The team can help you refine your efforts identifying inappropriate payments, fraud, waste and abuse. In addition, we can develop the workflows and process to rectify these aberrancies. Utilize Engage to provide workable solutions for your team.
SELF-SERVICE DATA SOLUTIONS
Actionable Data that Reduces Recovery Costs
Now you can avoid costly outsourcing audit fees by identifying and recovering on billing aberrancies yourself. Utilizing Engage’s self-service analytical platform, your payment integrity team can:
- Create and deploy custom algorithms
- Deploy core algorithms across the claim spectrum
- Identify potential payment accuracy errors
- Prioritize findings for subsequent examination
- Analyze and report on identified trends, high utilization concerns or situations where payment accuracy is suspect
- Apply to pre or post pay situations
- Support from the Engage subject matter experts
With Engage, you can perform the analysis needed to determine where noncompliant billing situations arise. Using this information, claims can then be forwarded for immediate recovery, validation, or claim review.
MEDICAL REVIEW AND AUDITING
Augment your Program Integrity team with expert reviewers
One of Engage’s specialties is expert medical review and auditing services. Our team has developed, performed and supported claim audits in a wide variety of reimbursement situations. Our vast experience makes Engage the best partner for your internal team. Be it a reoccurring need or a flex resource to accommodate high inventory volumes, Engage can help you attend to your medical review and audit needs. This provides you with greater flexibility to meet demands while maximizing the ability to capture and correct billing errors.
The Engage team is multidisciplinary in design. To best meet the wide variety of program integrity needs, the team is comprised of board certified physicians, registered nurse auditors, coding specialists, contract validators and reimbursement specialists that can address all aspects of claim reimbursement. Regardless of the type of claim that you may need to review, the Engage team can rightsize the resource to meet our client’s specific need.
Medical Review and Audit Experience
- Coding Reviews – Inpatient and Outpatient
- Readmission Reviews
- Hospital Transfers
- Length of Stay Determinations
- Durable Medical Equipment
- Home Infusion Therapy
- Post Acute Care
- Labs and Genetics
HEALTH PLAN COST AVOIDANCE SOLUTIONS
- SELF-SERVICE DATA MINING
- CUSTOMIZED AUDIT PROGRAMS
- INTERNAL AUDIT QUALITY ASSURANCE
- EXPERTS ON AUDIT PROGRAM FOCUS & DEVELOPMENT
- PROVIDER ANALYSIS
- TRAINING, EDUCATION AND OUTREACH
- THIRD PARTY SOLUTION ANALYSIS
- POLICY DESIGN AND IMPROVEMENT
- FRAUD, WASTE AND ABUSE DETECTION
LINES OF BUSINESS
- MEDICARE
- MEDICAID
- MEDICARE ADVANATAGE
- COMMERCIAL
- FEDERAL EMPLOYEE PROGRAMS
- SELF INSURED
CONSULTING
Maximize Program Integrity Efforts
The team at Engage has decades of unique Program Integrity experience. Our team has developed, implemented, and operated pre & post-pay audit programs for the largest payers in the country. Even with the constant technological and policy changes that occur, the Engage team can meet the most stringent expectations.
Capitalize on this knowledge and expertise. Let Engage demonstrate how our cost avoidance solutions, based on best practices, can help your organization ensure more accurate reimbursements to your clients. Engage knows the strengths, weaknesses, and gaps inherent in most Payment Integrity programs. Our services are designed to ensure your program operates most effectively and efficiently. Engage is your best partner for Payment Integrity needs.
What Sets Engage Apart
High ROI
With Engage, our solutions drive high returns while keeping fees low. Furthermore, since our solutions are focused on correcting errors, the benefit is longer than traditional recovery approaches.
Quick Results
Engage can demonstrate results in less than 30 days. No long implementation times. Our lean implementation techniques do not require large resource lifts to get started. The Engage teams can hit the ground running.
Holistic Approach
Our solutions do not myopically focus on claim level errors. Rather, we look holistically to determine root causes and problem correction. Traditional PI programs aren’t Incentivized to help improve a PI program.
Flexible
With Engage, our solutions are not “one size fits all.” We offer a la carte options that can be customized to meet your specific needs. Not only is this an efficient and effective approach but it is one of the most cost-conscious ways to approach a Program Integrity program.
Solution Based
To lower error rates, we must go beyond identification and recovery. Pay and chase is hard on all parties. The knowledgeable team at Engage can implement best practice solutions to mitigate the repetitive errors and unnecessary spending.
