Highlight Health is at the forefront of the industry, providing best-in-class healthcare cost containment solutions and administration.
There are new laws, rules, and regulations, and every health plan in America needs a knowledgeable advisor who not only knows these rules but knows how to use them to the advantage of the Plan and its participants. No Plan should be unguarded. Every Plan should utilize Highlight Health.
Highlight Health uses advanced technology and data analytics to ensure that our clients are paying the right cost for healthcare services billed by providers.
We were founded in the early days of the Covid-19 pandemic and innovation is in our DNA. Highlight Health leads the industry with healthcare cost containment strategies, knowledge of new and emerging laws and trends, and the implementation of plan changes to save Plan sponsors’ money and increase their bottom lines.
Highlight Health provides defensible claim repricing for self-funded health plans
Highlight Health works with self-funded health plans, TPAs, brokers, stop-loss carriers, and other healthcare payers to deliver legal, expert, and accurate cost containment solutions.
Legal
Legal
We correctly apply federal and state laws, rules, and regulations to complex healthcare billing.
Expert
Expert
Our experts conduct a detailed analysis of every bill to identify and prevent overbilling.
Accurate
Accurate
Our work product is reliable and accurate based on our comprehensive and unconflicted review.
Highlight Health brings a heightened level of focus and scrutiny on the large medical claims that keep Plan sponsors up at night, including hospital inpatient claims, outpatient procedure claims, and large professional claims. In partnership with our clients, we segregate and analyze large claims using technology and knowledgeable experts, post-auto adjudication and before they are paid. We also work with post-payment claims. While Highlight Health cannot reduce the cost of every claim that we examine, our data proves that we can reduce the cost for most claims. Reducing the cost of even just a handful of large claims often yields large savings to plan sponsors and their stop loss carriers.
Large claims have a massive impact
Total Number of Medical Claims for Billed Charged Over $25,000
Total Allowed Amount for Medical Claims Over $25,000
Claims Analysis for Northeast Public Employer with 25,000+ Plan Participants, Calendar Year 2023
Highlight Health is proud of the transparency and defensibility of our work. When we assign a price to a claim, it’s a price that we are willing and able to defend using:
Highlight Health’s work is defensible and reliable. Our clients and other stakeholders can request a detailed justification of our price, which is presented in writing and with the appropriate support and citations.
When a client sends us a claim, in virtually any format, our proprietary technology stack and experts immediately get to work. We examine the claim from every potential cost reduction angle. Because we are independent and work for plans, no potential reduction is “off the table” and no claim is non-challengeable.
We reduce improper charges and identify fraud, waste, and abuse. We ensure that our clients’ health claims are paid appropriately. Our work helps our clients avoid paying erroneous and legally unsupported claims that unnecessarily inflate healthcare spending but unfortunately are all too common.
Ask Us QuestionsThink about it
Most of us don’t carefully review the calculations of the scanner at the grocery store.
Few of us, however, would buy a house without an inspection. Yet, every day, claims that cost self-funded health plans the value of a new house – and much more – auto-adjudicate and are paid without any examination.
Reliance on black-box, auto-adjudication for large claims needs to end.
Plan fiduciaries and their vendors need to exercise right and duty to carefully examine these claims and stop the overpayments.