Featured Managed Care Vendor
Health Decisions can help you recover 2 to 3 percent of your paid claims.
Health Decisions, Inc. (HDI) is among the most comprehensive and sophisticated post payment health claim recovery
services in the industry. Nobody addresses more recovery areas, offers a lower recovery threshold, or recovers a
greater amount of money per client than HDI. HDI claim recoveries occur in the following areas:
- Coordination of Benefits (All Claims Greater than $10)
- Medicare Responsibilities (ESRD, Retirees, Disabled)
- Claim Payment Verification (Ineligibles, Duplicates, Correct Fees)
- Judicial Judgments (Divorces, Workers Compensation, Subrogation)
Health Decisions’ claim recoveries are “non-routine”, occur in even the best health plan claims processing systems
and do not require any changes in current health plan claims adjudication processes. These new recoveries are
collected because HDI gathers additional information not known at the time of original adjudication; and, HDI
performs special recovery processing to collect on complex or contested cases (such as Medicare coordination).
Health Decisions has served hundreds of client groups over the last 15 years of operation. Their clients include
HMO’s, BCBS-Michigan, insurance companies and large self-funded employer groups like the State of Michigan,
Masco and Detroit Diesel.
During 2000, HDI processed almost two billion dollars of paid claims.
Typically, HDI is compensated on a contingency basis - keeping 33 percent of recovered claim amounts. For health
plans which collect the identified recoveries, however, lower contingency fees are available. HDI is also willing to
enter into a multi-year fixed fee software lease arrangement if the client so desires.
For more information, contact your Summit Re Account Executive.
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