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MultiPlan helps healthcare payers manage the cost of care, improve competitiveness and inspire positive change. We use sophisticated technology, data analytics and a team with deep industry experience to interpret the needs of our clients, and then we develop innovative solutions to meet those needs by combining and tailoring our payment integrity, network-based, and analytics-based services.

Payment Integrity Services

Most payment integrity services rely on automation, published edits and policies. While effective for addressing obvious issues, they leave significant errors - and in particular waste and abuse - on the table. Through technology, clinical expertise and claim processing, MultiPlan Payment Integrity targets the complex issues that aren't addressable by computer alone.

Technology Layer
70% of the billing issues we find are complex clinical coding scenarios or suspect billing patterns

  • 200 million code combinations
  • Covering 90 service areas
  • Derived from actual claims/bills
  • Continually expanded

Expertise Layer
After analysis we pause to examine the findings, with physicians involved every step of the way

  • Accelerated process tuned for pre-payment
  • Deeper analytic processes for post-payment
  • Board certified physicians
  • Certified coders, licensed nurses

Action Layer
Our ability to pause and reflect lets us send more claims/bills down more paths to resolution.

  • Pre-payment actions including editing, medical record reviews, negotiation and education
  • Post-payment actions including claim audits, medical record reviews and recoveries

Service Layer
Education and support for provider appeals

  • Understandable explanations
  • Citations included to help minimize pushback
  • Portal access for payer and provider
  • Access to physicians as needed

Network-Based Services

MultiPlan delivers primary PPO, complementary network and specialty network access both nationally and in select regions of the country.

  • PHCS Network - offers NCQA-certified access in all states to over 4,500 hospitals, 70,000 ancillary care facilities and 700,000 healthcare professionals. It can be used as a plan's primary network, or can complement the primary network either to extend outside the plan service area, or to fill gaps in geographic or specialty access within the service area. Versions also are available for use with Medicaid programs in select markets.

  • MultiPlan Network - a complementary provider network that gives health plan participants an additional choice of providers at discounted rates. When commercial health participants seek care outside their primary network, they typically pay a higher coinsurance rate but share in the savings achieved by the network discount. Nearly 5,000 hospitals, 100,000 ancillary facilities and 730,000 healthcare professionals participate from all states. Versions also are available for use with workers' compensation, auto medical and select Medicare Advantage programs.

  • MultiPlan Centers of Excellence - a network of facilities offering contracted savings on a variety of organ and stem cell transplant procedures - all of them offered under global case rate arrangements which apply predictable, fixed charges throughout the hospital stay. The network supports 13 types of transplants including kidney, heart, heart/lung, bone marrow and intestinal. Over 350 transplant procedures are offered by more than 50 facilities. Search for participating facilities and their contracted programs.

  • ValuePoint by MultiPlan is our national discount card network. Discounts are offered in exchange for payment in full by the member at the point of service. Click here to learn more about ValuePoint.

  • Regional primary networks are available in Wisconsin, under the HealthEOS brand; Alaska and Nevada, the Beech Street brand; Hawaii, under the HMN brand; and in Arizona, under the AMN and RAN brands.

Analytics-Based Services

By using MultiPlan's PPO networks, you will significantly reduce your exposure to non-network claims and increase your healthcare savings. But even the most robust PPO networks in the industry won't fully protect you from costly non-network rates. That's why MultiPlan offers two options to protect you from the uncontrolled costs of non-contracted healthcare services:

  • Negotiation Services. Using a number of sophisticated benchmarks, our team of more than 300 negotiators reach out to non-contracted providers to negotiate reductions on specific claims. The provider signs off on any savings applied to the claim, ensuring your members aren't billed the difference between original and negotiated charges.

  • Medical Reimbursement Analysis. Using extensive cost data and claims history, recommended reductions are made to more closely align reimbursements with similar claims at similar providers. To maximize provider acceptance, our programs handle provider inquiries and also help patients who may be billed by the provider for the balance.

Clients can include one or both of these services in their cost management solution, and those who use both can choose which service is accessed first.