EBPA’s Cost Containment Management is built around a claims transaction system that encompasses a full spectrum of services. Our state-of-the-art system leverages the benefits of having multiple claims services integrated into one entity on one claims platform.
We've selected the best-of-breed companies in each process area - Preferred Solution Partners - to integrate with our system. Along with our powerful claims processing engine, our clients receive the best of traditional cost containment services:
Medical necessity review of both inpatient and outpatient procedures is integrated with our own nursing staff and our URAC accredited partner, American Health Holding. Clinical professionals benchmark against Milliman Health’s days per 1,000, admits per 1,000 and average length of stay criteria to certify treatments. Cases are continually monitored to ensure quality and appropriateness of care, and we report all never events and avoidable hospital conditions.
Payer claims management system that integrate with our claims transactions system to identify fraud, waste and abuse. Increases savings opportunities by proactively uncovering improper claims before payment. Powered by The Emdeon EDGE Fraud, Waste and Abuse Protection Suite, it is estimated that we avoid payment errors and claim overpayments, reducing overall paid claims by 5-10% annually!
Our integrated partnership with the Phia Group allows our clients attorney consultation, considered throughout the industry to be the most innovative leaders practicing today. Our team also works with the Phia Group to review existing plans, with an eye towards improving each plan’s subrogation rights.
No software system is better than actual experience, so we've built workflows and processes designed to deal with:
- Large Claim Impact/Notification
- Out of Network Claim Review and Notification