Catastrophic Claim
Solutions
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PRODUCT HIGHLIGHTS

FOCUSED OBJECTIVE REVIEW MANAGEMENT

Advantria’s sole focus is the case/claim at hand. The expertise, data and experience of each partner on the case can be leveraged by Advantria to ensure an objective, overall view of the case.

Further, this review and management by Advantria allows our partners to concentrate on their own, specialized, ongoing, day-to-day claim operations.

 

Advantria performs a no cost review of large dollar claims to determine if the current reimbursement is appropriate for that specific case. Advantria works with all of the partners involved to ensure the review encompasses every possible data point rather than too narrow a focus. This overall review ensures each partner’s expertise is used to the benefit of obtaining the best reimbursement in light of all the competing factors.

PRODUCT HIGHLIGHTS

FOCUSED OBJECTIVE REVIEW MANAGEMENT

Advantria’s sole focus is the case/claim at hand. The expertise, data and experience of each partner on the case can be leveraged by Advantria to ensure an objective, overall view of the case.

Further, this review and management by Advantria allows our partners to concentrate on their own, specialized, ongoing, day-to-day claim operations.

 

Advantria performs a no cost review of large dollar claims to determine if the current reimbursement is appropriate for that specific case. Advantria works with all of the partners involved to ensure the review encompasses every possible data point rather than too narrow a focus. This overall review ensures each partner’s expertise is used to the benefit of obtaining the best reimbursement in light of all the competing factors.

THIS REVIEW CAN BE CONDUCTED ON BOTH IN NETWORK AND OUT OF NETWORK CLAIMS.

CLAIM NEGOTIATION/ARBITRATION

If Advantria finds the existing reimbursement is not appropriate or may be improved, we will work directly with the medical provider(s) to obtain a fair, objective reimbursement. This third-party negotiation protects all partners by ensuring that a one off, high dollar case does not affect day-to-day claim processing relationships. This allows Advantria to work on both in network and out of network claims.

SECURE SETTLEMENTS

Whenever a settlement is secured, Advantria obtains an agreement, signed by the provider, specific to that case/claim. This ensures all parties understand what payment(s) is forthcoming and that the member is not billed for the difference between the final settlement amount and the original billed charges.

Fees are paid on a contingency basis and based solely on the results obtained by Advantria on a specific claim. If Advantria is unsuccessful, there are no fees.

ONGOING CONSULTING SOLUTIONS

Since Advantria manages and focuses only on large dollar, problem cases, we can bring a unique focus to reporting and consulting on possible solutions for these claims. We periodically evaluate the results of the claim review and negotiation process and generate reports that highlight these claims and their ultimate outcome. Based on this, we work with partners to examine other possible solutions and/or other potential process improvements.

CLAIM NEGOTIATION/ARBITRATION

If Advantria finds the existing reimbursement is not appropriate or may be improved, we will work directly with the medical provider(s) to obtain a fair, objective reimbursement. This third-party negotiation protects all partners by ensuring that a one off, high dollar case does not affect day-to-day claim processing relationships. This allows Advantria to work on both in network and out of network claims.

SECURE SETTLEMENTS

Whenever a settlement is secured, Advantria obtains an agreement, signed by the provider, specific to that case/claim. This ensures all parties understand what payment(s) is forthcoming and that the member is not billed for the difference between the final settlement amount and the original billed charges.

Fees are paid on a contingency basis and based solely on the results obtained by Advantria on a specific claim. If Advantria is unsuccessful, there are no fees.

ONGOING CONSULTING SOLUTIONS

Since Advantria manages and focuses only on large dollar, problem cases, we can bring a unique focus to reporting and consulting on possible solutions for these claims. We periodically evaluate the results of the claim review and negotiation process and generate reports that highlight these claims and their ultimate outcome. Based on this, we work with partners to examine other possible solutions and/or other potential process improvements.

Contact us

5625 Alpinista Circle
Reno, NV 89511

sales@advantria.net
866-756-8666 x200

 

Contact us

5625 Alpinista Circle
Reno, NV 89511

sales@advantria.net
866-756-8666 x200

 

© Advantria 2018