Out-of-Network Claims Repricing

One of the areas most overlooked by medical professionals and other healthcare payor and provider organizations is how to effectively deal with out-of-network and out-of-area claims.

Efficient out-of-network claims repricing can, if done properly, result in substantial cost savings and increase profit margins. Out-of-network claims repricing can result in savings for employers, insurers, and even patients. Out-of-area and out-of-network claims repricing focuses on generating savings on medical bills from companies that do not utilize PPO or HMO networks.

And even when PPO and HMO networks are utilized there are still out-of-network claims that will need to be processed… an estimated 10% to 30%. A quick, yet effective way to determine if using a claims repricing solution is worth the investment is by performing a savings analysis. Get the prospective vendor to take some of your actual out-of-network claims and run an analysis on them against historical data to determine what the expected savings may be.

At A&G HealthCare Services we offer one of the medical industry’s best out-of-network and out-of-area claims repricing solutions. We are medial cost containment specialists highly proficient in medical bill reviews, out-of-area/ out-of-network claims, negotiated discounts, medical audits, and medical funding. Use our medical repricing services and solutions and reap the benefits of reduced costs, streamlined operations, and improved profits.

A&G belongs to one of the largest medical networks in the U.S. and has access to 55,000 hospitals/ clinics and more than 1-million healthcare providers. Our clients save anywhere from 15% to 50% using our fully EDI ready, HIPAA compliant medical repricing solutions!

A&G’s Amera-Net Travel Wrap PPO Network is an out-of-area and out-of network claims repricing solution designed to address the needs of travelers. It helps to control costs of out-of-area and out-of-network claims by wrapping around or combining with your selected Primary PPO network.

For more information about our out-of-network claims repricing solutions and other repricing services, call 972-312-8589 x112 or email info@aghealth123.com.