Unscrambling The Egg, Health Decisions Inc. Recovers Money After Health Insurance Claims Are Paid

Giant health care insurers and mid-size to large corporations can improve profits by recovering money after health insurance claims are paid. Health Decisions Inc. a national leader in group health claim recovery, serves commercial insurers, HMOs, self-funded companies, consultants, brokers, union trusts, and government entities.

Plymouth, MI October 6, 2004 -- A Plymouth company has positioned itself at technology's edge so it can assist giant health care insurers and mid-size to large corporations improve profits by recovering money after health insurance claims are paid.

Health Decisions, Inc. has the power to review claims already paid and find enough income in unpaid claims to produce up to a 10-1 return for clients.

"Our company is a pioneer as we are the first and only one involved in Post-Payment Administration," explains Si Nahra, PhD, President of Health Decisions, Inc. of Plymouth. "After everyone else is finished, we apply our expertise, methodology and powerful software tools and dig even deeper to uncover more money for self-insured employers and health insurance companies."

Post-Payment Administration, akin to unscrambling the egg, finds money to recover after health claims have been paid by insurance companies or self-insured corporations.

Each year Health Decisions investigates over $250,000,000 in claim payments and identifies a recovery potential of 1-3%. Health Decisions's software is so powerful that it identifies more recovery cases in an hour than manual reviewers can do in a week.

Health Decisions, a national leader in group health claim recovery, serves commercial insurers, HMOs, self-funded companies, consultants, brokers, union trusts, and government entities.

Among its client lists are Blue Cross Blue Shield of Michigan, IBA Health Plan, Compuware, Detroit Diesel Corporation, Elias Brothers, General Motors, Kellogg Foundation, MASCO Corporation, Michigan Beer & Wine Wholesalers Assn., R.L. Polk, Oakwood Health Services, St. John Hospital, the cities of Detroit, Ann Arbor, Pontiac and several school districts.

"When we take a look at the last 2-1/2 years, Health Decisions has recovered in excess of $128,000 for only $52,000 in expense," says Richard A. Gasowski, director of risk management and safety for Macomb County.

Health Decisions goes much deeper, seeking claims to recover by conducting a review of 100 percent of claims in more than 30 areas to identify and recover claims paid that are not the client's responsibility. This service routinely produces a positive return-on-investment, says Nahra.

In addition to claim recovery, Health Decisions conducts a formal audit of claim payer procedures and performance and identifies and corrects errors or omissions made by claim payers that are increasing plan costs and legal liability.

Health Decisions also offers specialized staff to conduct a complete Enrollment Verification Survey of all covered persons with the full range of information needed for claim administration and regulatory compliance, including new HIPAA regulations.

"Employers using our services can save 1-3 percent of paid claims by finding facts that were not known when the claims were originally paid," explains Nahra. "Companies also will improve employee relations by helping them get the full value from all coverages due them. And we will help employers avoid federal and state regulatory liabilities."

"Most insurers have taken traditional cost-containment efforts to the limit," says Judy L. Mardigian, Chief Executive Officer of Health Decisions, Inc. " Benefit design changes and creative financing arrangements no longer provide the savings that are needed in today's highly competitive benefits marketplace."

The only way to reduce risk and improve profitability is to lower actual claim costs, stresses Nahra, and that is exactly what Health Decisions does. "Some insurers already have claim recovery efforts in place for subrogation or other areas," says Nahra, "Health Decisions does not disrupt or change these existing relationships. We perform our reviews and pursue only those claims not already identified by existing recovery efforts."

Data in Health Decisionss system is edited, checked for accuracy and reconciled to assure quality data that complies with HIPAA and other regulatory requirements. The data is integrated with external files to get all available facts and is converted into Microsoft Word, Excel and web-compatible formats.

About Health Decisions:
Health Decisions, Inc., a privately owned, Michigan Corporation, specializes in benefit data management services to clients throughout the country.

Since 1985, Health Decisions, Inc. has successfully served hundreds of clients -- HMOs, insurers, TPAs and self-funded groups of all sizes. The firm successfully processes annually more than a billion dollars of paid claims data and processes special surveys for more than 225,000 covered members.

Health Decisions has taken its core competencies of technical expertise, data sophistication, and a pragmatic service orientation and developed a series of products with proven value and considerable potential for growth.

Health Decisions, Inc. distinguishes itself with its service philosophy: Respect for existing procedures; emphasis on customization; and, focus on solutions

For further information about Health Decisions, Inc. services and its pioneering Post Payment Administration program go to www.healthdecisions.com, send an inquiry to Health Decisions@healthdecisions or call 800.589.2500.
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