Best in class savings coupled with superior risk management

Medical Claim Advisors is a medical claim negotiation company that provides risk management applications that significantly reduce claim costs for any type of Payer.

Image 1

Medical Claim Advisors is a medical claim negotiation company that provides risk management applications that significantly reduce claim costs for any type of Payer.

Image 1
Image
What makes us truly unique is that our team consists of former and current clinicians with extensive negotiating, auditing and billing experience.
Icon We have a vast trove of provider reimbursement data and technological resources that enable us to negotiate appropriate reimbursements.
Medical Claim Advisors negotiate discounts on medical claims for clients that include:
  • Third Party Administrators
  • Self funded employers and unions
  • Reinsurers, stop loss carriers and MGUs
  • Self funded employers and unions
  • Health insurance carriers
  • Bankruptcy Trustees and law firms specializing in bankruptcies and liquidations
  • Receivership management companies
  • Individuals overwhelmed by medical bills
Team photo
MCA utilizes a risk management approach that dramatically reduces or eliminates liability. Providers are bound to the settlement amount and the Agreement eliminates the potential for balance billing. Product portfolio consists of:
1 Claim negotiation

MCA has a vast proprietary database of reimbursement data that is utilized during the negotiation process. We create a negotiation band utilizing Medicare reimbursement as a base. A variety of factors and metrics are taken into consideration in determining the final reimbursement. Our team works to obtain a mutually agreed upon settlement, realizing the best savings without jeopardizing member satisfaction. A key element to our process is that once an agreement is finalized we obtain 100% sign off from every provider on every single negotiated claim. Each signed agreement is shared with the Payer and we archive all Agreements.

2 Advanced Funding

MCA can utilize a funding mechanism that allows for prefunding or funding at the point of negotiation. If a future encounter with a provider has been or will be established in a specified time frame we can pre-negotiate discount for the service. If a claim has already been generated then we can offer funding at the point of negotiation. This approach is typically utilized for certain high dollar claims and it usually will elevate the discount.

3 Audit/Bill Review

MCA applies medical and reimbursement edits. Registered nurses and physicians manage the audit process. This is a line-by-line review of the claim. An in depth review of all medical records is performed.

You Got the Q, We’ve Got the A

Q How long does it take to implement?

Claims can be sent immediately.

 A
Q How long does it take to negotiate a claim?

3 to 5 business days is the typical time frame.

 A
Q How can I submit claims?

Send securely via email or fax to 610-565-1682. Large batches can be sent via an FTP site.

 A