Meritain health timely filing limit plus#

Savings are captured on approximately 91 percent of out-of-network claims, with an average savings of 61 percent.

An audit process on paid claims is also used to catch errors and maximize savings. For instance, in-network claims over $15,000 *, as well as out-of-network claims over $15,000 are subject to a line-by-line review to capture additional edits, or savings recommendations.

Meritain health timely filing limit plus#

However, we have processes tailored to high-dollar claims, plus in-network versus out-of-network. What strategies do we employ? This may depend on the amount of the claim and network terms. In addition, proactive review helps our clients address claims issues and take control of their benefits spending. To obtain the most cost-effective pricing on behalf of our clients, we utilize specific cost management strategies in the claims process. Our rule sets are designed to stay current with the market and provide deeper support for the changing complexity of self-funded plans. Additionally, strategic in-house claims editing processes are applied using proprietary claims editing software. Then, claims are evaluated, adjudicated or repriced, if necessary, and savings are applied. Does the claim date fall within the right effective dates for the employer group?.Is the member eligible for services on the claim?.This helps us determine validity of the claim, considering things like: When we first receive a claim-either electronically, by paper or manually-an initial review is always performed. Our strategic approach is how we proactively look for savings. In fact, we have a cost management strategy for most claim situations, including in-network, out-of-network, high-dollar, complex, pharmacy, fraud, waste and abuse, and dialysis claims. We focus on timely handling of claims, but also have upfront claims editing practices to help with managing costs. So, when it comes to the life cycle of a claim, here’s what you can expect to see. Luckily, at Meritain Health®, claims handling is something we know a lot about.

Whether you’re an employer or a member, you might wonder what happens to a health care claim once it’s submitted.