Reference-Based Pricing technologies and Claim Surveillance

  1. Our proven innovative pricing technologies allow healthcare payers to optimize reimbursements for all healthcare transactions by benchmarking claims. The pricing engine utilizes extensive data sets to determine the prevailing price, cost and value for all medical services. Claim surveillance examines every claim automatically and benchmarks results against Medicare pricing, cost, average reimbursements, commercial claim payment, reasonable and customary databases and proprietary data bases. This is our Turn-key claims cost management solution. 

    Once the prevailing price is established, our seasoned negotiators present the findings to the provider and secure a negotiated sign-off agreement based on the reduced amount. This ensures payment-in- full with no balance billing to the member.

  2. HST provides pricing data services to support your cost containment solutions.  Our pricing and cost data allows you to benchmark against Medicare pricing, costs and our proprietary databases with tailored results based on your risk tolerance.  We can customize our solution to meet your needs and turn-around times. 

  3. Our medical appropriateness looks for redundant & duplicate charges, unbundling, experimental drugs, capital equipment, routine nursing, inappropriate charges, unidentified and incomplete charges.  Claims requiring further investigation are flagged for specialist review.

 

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Irvine, CA 92618

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