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Your organization has claim payment policies and benefit language that distinguish you from others who pay or administer health claims. But there is one thing you have in common, the need to improve claim quality and strengthen the bottom line.
Competitors run your claim data through a generic "black box" giving them a limited perspective. They aren't able to establish patterns and trends or perform detailed analyses. And because they're generic, they can't adjust their rules to compare claim payments to specific payment policies.
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At End-Game Strategy, we examine claim data in depth - looking for explanations, offering solutions.
As consultants, our specialties are Post-Payment Overpayment Identification and Quality Auditing. And in both areas, our "secret weapon" is Post-Gametm, a powerful, flexible, advanced data mining tool that is custom-tailored to thoroughly address your specific needs, policies and priorities - giving you a resource and capabilities you could never get off the shelf.
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A provider gets paid twice for the same service.
Post-operative visits pass through the system as payable
charges instead of being recognized as surgical follow-up.
And that’s just the tip of the iceberg!
Time and again, as we examine a new client’s claim data, we find overpayments in dozens of categories, repeated over and over without being detected.
Our strategy is to dig deep into your claim history,
identify the problems and the patterns, and help you
make sure that history doesn’t repeat itself.
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