Enhanced Claims Control
A Fine Tooth Comb for Savings
When it comes to keeping costs low, our Enhanced Claims Control (ECC) solution closes gaps and helps ensure our clients’ money is being spent where it should be. This comprehensive set of services and tools is designed to reduce costs throughout all aspects of a client’s plan.
Our ECC solution is so effective that our clients see up to 60%* savings on their out-of-network claims.
Our ECC solution is so effective that our clients see up to 60%* savings on their out-of-network claims.
Explore ECC's services and tools designed to help reduce costs:
Hospital Bill Auditing
We have special processes to scrub itemized bills, review doctors’ orders and identify any billing issues. We then work with the facility to help resolve any questionable charges so clients aren’t stuck overpaying.Dialysis Cost Management
Dialysis care can be costly and long-term. We provide specialized claim review, care management and support, and discount negotiation for the course of treatment.Medical Specialty Drug Management
Powered by Archimedes, LLC, we provide employers with a complete specialty drug management solution backed by near real-time data that addresses total medical specialty drug spend, regardless of benefit design or configuration.Out-of-Network Discounts and Fee Negotiation
Discounted healthcare doesn’t have to be limited to in-network providers. If members visit an out-of-network provider, we provide a multi-tiered hierarchy of programs designed to take advantage of contracted discounts, cost-based reimbursement determinations, or negotiations.Fraud Services
With the industry experts at Covent Bridge, we use the latest in comprehensive investigative technology to mitigate risk for claims with a propensity for fraud, providing our clients with peace of mind and driving savings.Subrogation Review
Our team performs an in-depth review of paid claims and screens for other liable parties, and if we discover another at-fault party, we’ll work to help our clients recover any associated paid claims.Waste and Abuse Protection
We bring sophisticated technology similar to what’s used to monitor credit card purchase patterns to analyze historical claims for questionable provider billing patterns. We also use experienced waste and abuse-fighting experts to ensure claim dollars are being spent on valid claims, not bogus or padded ones.Services We Review
Our Enhanced Claims Control solution finds savings by reviewing billing itemization, medical records, physician notes/orders, lab/radiology reports, patient notes, and Rx and IV administration details for the following types of services:
Transplants
Specialty Drugs
Chemotherapy Drugs & Radiation
Pain Management
Spinal Surgeries
Unlisted Codes
Drug Testing
Bone Growth Stimulators
Dialysis
Experimental & Investigational
Large High-dollar Claims
Connect with a Luminare Health sales executive to learn more.
Availability of services and tools is based on network eligibility. Please contact your Luminare Health client manager for more information.
*Average gross savings, Luminare Health Book of Business, 2020. Fees for Enhanced Claims Control are a percentage of any savings found.