Highlight Health provides pre-payment claims review and defensible repricing for our clients. We focus on pre-payment reviews because it’s much easier for a plan to make the first payment the correct payment than it is to identify and recoup an overpayment after it has already been paid.
For decades, self-funded health plans with network contracts were inexplicably told that the prices they were directed to pay by their networks and claim administrators were “proprietary and confidential” and could not be shared with them. By law, beginning in 2021, health care contractual prices are no longer proprietary and confidential and plans, as responsible and diligent plan fiduciaries, are expected to ask questions about their payments.
As the industry leader in prepay claims review, Highlight Health provides payment integrity services to self-funded health plans and stop-loss insurers. Our services take into account the deep and complex patchwork of laws and regulations that govern healthcare billing, and our team members provide expert and accurate results.
Legal
Legal
We correctly apply federeal and state laws, rules, and regulations to complex healthcre 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.
Key benefits for self-funded health plan clients include
- Lower claim costs
- Avoiding payment errors before claims are paid
- Lower administrative costs by reducing “pay and chase”
- Maintaining positive provider relationships while ensuring payment integrity
Highlight Health differentiators include
- Highest savings in the market
- Our focus on large claims
- Our expert performed, comprehensive reviews — with are not a one-savings-methodology shop
- Work that is documented, reliable, and defensible
- Our loyalty to self-funded plans and their stop-loss carriers, without conflicting relationships