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Customized solutions for commercial healthcare payers

Customized solutions for commercial healthcare payersHelping healthcare payers and their plan members strike the ideal balance between service quality and cost
Nine of the Top 10 Trust MultiPlan MultiPlan services drive cost management solutions for nearly every large insurer by market share, as measured by NAIC.Our Services in ActionCustomize a solution to solve any healthcare cost management problem

Choose and arrange from the industry’s richest set of services designed to reduce medical spend before you pay.

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Payment Integrity ─ What We Find
Complex Issues (60%)Many findings need physician and/or coder review to confirm:
  • Unlikely procedure combinations
  • Overlapping procedures
  • Contradictory procedure combinations
Suspect Scenarios (10%)Needs physician review and may require more documentation:
  • Potentially excessive services
  • Unusual services reported
  • Provider profiling (e.g., physical therapist reports the same services on every bill)
Simple Issues (30%)Generally found by claim editing software, but often overlooked:
  • Units above maximum likely levels
  • Inappropriate use of modifiers
  • Multiple procedure discounts
  • Unbundling
Defensible and Effective Pricing

Whether using networks or not, it’s always better for a plan and its members to work in tandem with providers, and not against them, to manage medical spend. For pricing of non-contracted claims, MultiPlan’s Data iSight and Viant services offer defensible methodologies, integrated provider inquiry and resolution management, and a unique patient communication program designed to deliver support when balance billing does occur.

Learn more about why Data iSight has over 90% provider acceptance.

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Our Commercial Healthcare Networks

4,800 primary network hospitals

5,000 complementary network hospitals

94,000 primary network ancillary care facilities

113,000 complementary network ancillary care facilities

797,000 primary network practitioners

836,000 complementary network practitioners

Strategic Negotiations

MultiPlan’s negotiation technology features all the tools needed for success. It also supports unique options to customize negotiation strategies, so clients get the best results for their health plans. For example, MultiPlan can establish negotiation parameters reflecting a plan’s benefit limit, giving the provider a better understanding of the value of their signed agreement, and improving both success and savings. 

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Contact UsImprove competitiveness and reduce medical spend. Use MultiPlan's payment integrity and cost management services to customize solutions for you and your clients. Learn more