Oct 29, 2024 | Alternative Reimbursement Strategies, Chronic conditions, Client Report, Cost projections, Cost Savings, Direct-to-Employer Contracting, Drug costs, Fair market reimbursement, Forensic claims review, Health care costs, High-cost claims, MedBen Rx, MedBen WellLiving, Prescription, Rx Costs, Transparency, Trend, Wellness
Health care costs in the United States are projected to see their steepest rise in over a decade during 2025, with multiple industry analyses forecasting increases between 7% and 8% year-over-year (see table below). However, MedBen offers solutions that directly...
Oct 14, 2024 | Alternative Reimbursement Strategies, Forensic claims review, Kurt Harden, MedBen News, Pharmacogenomics, Precision medicine, Quality, Wellness
On October 1, MedBen Chairman and CEO Kurt Harden spoke on the topic “A Third-Party Payer’s Approach to Providing Quality Care While Minimizing Cost” at the 2024 Ventegra Client Conference. Ventegra serves as MedBen Rx’s pharmacy benefits partner....
Apr 2, 2024 | Case Studies, Claims, Claims Management, Claims negotiation, Cost Savings, Forensic claims review, Savings
Claim savings don’t have to end with the PPO network discount. With MedBen’s forensic claims review services, savings are produced after network discounts are applied, but before claims are paid. As the case study below shows, while PPO network discounts alone...
Nov 27, 2023 | Case Studies, Claims, Claims negotiation, Cost Savings, Forensic claims review
A MedBen client realized an overall savings of 62% through repricing, forensic claims review, and provider negotiation. The client in question received a claim for IV infusion to a member with iron deficiency. After the PPO discount, MedBen saw an opportunity to...
Sep 5, 2023 | Alternative Reimbursement Strategies, Claims, Comparative Effectiveness, Cost Savings, Direct-to-Employer Contracting, Drug costs, Fair Market Pricing, Forensic claims review, High-cost claims, Inflation, MedBen Rx, MedBen WellLiving, Reference-Based Pricing, Rx Costs, Savings, Self-funding, Specialty Care, Survey, Wellness
A new survey by International Foundation of Employee Benefit Plans found employers expect plan costs to increase seven percent in 2024. As to why, they gave a range of answers, with the top four reasons representing 71 percent of responses (see chart below). As it...
Aug 4, 2023 | Algorithms, Forensic claims review, Lawsuits, Self-funding
In claims progressing, algorithms – mathematical formulas used to scrutinize particular elements of a claim form – can be good when used to ensure the accuracy and consistency of claim payments… but bad when used as a tool to deny claims. In a class action...
