TPA Success

Holding true to our commitment to strictly focus on controlling healthcare costs for our clients, Health Cost Control (HCC) established a partnership with one of the nation’s largest Third Party Administrators (TPAs) in order to help reduce the cost of their End Stage Renal Disease (ESRD) claims.

Our first step was to truly understand their business structure and to clearly define the pain points of the employer groups they represent. In doing so, we were able to conclude that ESRD for both In-Network and Out-of-Network claims was their biggest pain point. As such, we were able to outline a program that far exceeded their expectations in terms of clinical appropriateness of our reviews and the tremendous cost savings to the plans they represent.

In the six year partnership, we have reviewed thousands of claims on our client’s behalf which have resulted in over $62million in savings achieved. On a percentage basis, this equates to a 81% savings on the combined In and Out-of-Network reviews. In addition, considering the thousands of claims we’ve reviewed for this client, we’ve received less than a handful of appeals with 100% success in defense of those appeals on our client’s behalf.

These savings along with the very thorough clinical reviews, we were able to essentially double the results from their previous vendor. We continue to have a very strong partnership with our valued client.

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In Savings Achieved

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Savings on the combined In and Out-of-Network reviews

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