Fraud, abuse, coding errors, all lead to higher costs of healthcare. All the large health plans use technology to assure proper for payment for services and products delivered to their subscribers – medical claims payment integrity.
LHW offers superior payment integrity with its partner, Nokomis Health.
We help health plans save 5 to 9% on medical claims
Nokomis Health provides concurrent review of medical claims, helping multiemployer healthplans save 5 to 9% of the allowed amount for medical claims, which some clients seeing savings rates as high as 92% for out of network claims.
Nokomis works with your claims administrator to electronically review claims after they have been adjudicated but before they are actually paid. The proprietary, sophisticated analytics engine searches patterns within the data which may indicate fraud, waste, or abuse. Whenever necessary, record reviews are completed, and claim edits are applied or records may be requested from the practice or facility to justify the charges.
Where applicable, Nokomis obtains medical records and ensures that all charges are correct and supported by documentation. They review both professional and facility claims and, when appropriate, conduct line-item audits on hospital claims.
Even if the client uses their own code edit software or works with another claim review company, Nokomis’ 360 degree approach to claims is proven to find savings for their clients.
Claim review savings are found when:
- Charges not supported by documentation
- In-network claims incorrectly processed as out-of-network and vice versa
- Billing errors on claims
- Out of network claim negotiation
- Fraudulent or duplicate claims
No savings, no payment
No up-front fees, implementation fees, or monthly minimums – you only pay a percent of savings
The greatest results are obtained by using the concurrent claims preview service by Nokomis. Post-adjudication medical claims are reviewed prior to payment. Savings across the entire medical claims cost average 5-9%.
Out of Network Claims
Nokomis can review only out of network claims. While a smaller portion of the entire medical cost, out of network claims can be very costly for a health plan. Nokomis was able to save a client $2,091,000 on out of network billed charges of $2,277,000, a 91% savings rate.
With Nokomis there are no up-front fees, implementation fees, or monthly minimums. Their standard fee structure is a percent of the savings they recommend. No savings, no payment.
Health plans see savings, on average, of 5-9% of the allowed amount for medical claims. Individual results will, of course, vary depending on a number of factors. But regardless of the savings, you only pay a percent of the recommended savings.