Health Care Insight

Lovelace Health Plan Selects HCI

To strengthen its claims-management operations and further manage costs, Lovelace Health Plan is integrating HealthCare Insight’s PhysicianClaim Insight™ code editing and clinical review service into its claims review processes. The PhysicianClaim Insight™ service will ensure accurate claims reimbursement and identify aberrant provider activity that may indicate fraud.

“Physician offices and hospitals are very sophisticated in their knowledge of coding. It is essential for us to have the expertise and tools to reimburse services in an appropriate manner,” said Ruth Blea, director of Claims, Appeals and Training at Lovelace Health Plan. “HCI is the ideal partner for us. They provide the combination of superior coding editing applications and the experience and expertise of certified clinical and fraud specialists to enable us to provide value to our providers and members while improving the management of our bottom-line costs.”

Lovelace Health Plan, located in New Mexico, covers more than 2,000 employer groups and thousands of Medicare-eligible individuals and their families. The PhysicianClaim Insight™ service will improve its claims review; provide support in instances of appeals; and identify suspect provider billing practices.

“HCI’s applications are superior. They are very user friendly, flexible, and are complemented by its clinical experts who have an incomparable knowledge of today’s up-to-the-minute coding practices. With HCI we are confident that provider claims are paid correctly,” Blea said.

PhysicianClaim Insight™ is a prepayment fraud, abuse and overpayment prevention service designed to maximize claims payment accuracy, identify fraudulent providers and reduce professional claims costs. This service combines HCI’s proprietary Code Validator Pro™(rules-based) and FraudFinderPro™(profiling) software systems with claims review by RN Coding Specialists and suspect provider validation by a Clinical Investigative Unit (CIU). Payors that integrate PhysicianClaim Insight™ into their claims adjudication operations realize savings from $1 to $5 per member per month (PMPM) over and above existing claims payment processes.

“It is rewarding to have earned the confidence of Lovelace Health Plan as a trusted partner,” said Jack Tait, executive vice president of sales and marketing at HealthCare Insight®. “Lovelace has a clearly defined vision of how fraud, abuse, and overpayment
prevention services can help them achieve their business and service goals. We look forward to working with them to optimize their claims management processes.”

About Lovelace Health Plan
Since 1973, Lovelace Health Plan has worked closely with physicians to design programs and benefits that keep plan members healthy and informed of their choices. Today, Lovelace offers a full portfolio of managed care plans, providing insurance coverage for more than 190,000 people in communities across New Mexico. Our health plans cover more than 2,000 employer groups and thousands of Medicare-eligible individuals and their families.

About HealthCare Insight® (HCI) HCI provides health care claims payors with a comprehensive suite of cost reduction services focused on identifying and preventing health care fraud, abuse and overpayments. Implementing HCI’s entire line of technologically superior services can deliver savings up to $10 per member per month (PMPM). Each of HCI’s services rely on a sophisticated prevention process that combines cutting edge Code Validator Pro™ and Fraud Finder Pro™ software systems with detailed review by Clinical Coding Specialists and a Clinical Investigative Unit (CIU) on 100% of suspect claims and billing patterns. This unique combination of human and system review creates a service unlike any other in the industry and provides payors with unsurpassed support and claims payment accuracy. HCI’s services are seamlessly integrated into all claims adjudication operations and are affordable for payors of all sizes. For more information and your free Cost Reduction Analysis (CRA) please visit HCI online call 1-800-357-7781.

Contacts:
Darin Johnson, HealthCare Insight®, 801-990-1805
Chris Cervini, Lovelace Health System, 505-903-0367