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All Services

Claims Negotiation & Repricing

Sometimes, providers bill more than is appropriate for the services they deliver. When they do, our self-insured clients have us negotiate discounts on their out-of-network claims and on larger in-network claims (when it's allowed) and we excel at it. Our attorney negotiators start by examining each claim to identify any obvious errors.

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hhc group servicesClaims Editing

HHC utilizes Claims Editing to identify costly errors on claims of all sizes from hospitals, physicians, or any other medical providers.

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hhc group servicesLine-Item Bill Review

Medical bills often contain costly errors or the charges on the bills are out of line with what is being charged by other providers in the same market (Usual & Customary). For large in-network (when allowed) and out-of-network claims, H.H.C.'s clients have us conduct Line-Item Bill Reviews (LIR) to ensure they are not paying for items erroneously included in a bill.

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hhc group servicesClaims Auditing

Like Line-Item Reviews, clients typically use our Claims Auditing service for large dollar claims. At HHC, we utilize registered nurses, who have earned the certified professional coder designation, to conduct claim audits.

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Medicare Reference-Based Pricing

With Medicare Reference-Based Pricing (RBP), payers (self-funded employers, health plans, etc.) of all sizes can get in on the savings, enabling them to control their healthcare related costs short and long-term.

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DRG Validation

Errors can result in thousands of dollars of overpayments. H.H.C. offers payers DRG Validation services to ensure the input to the medical records is correct, the diagnostic and procedure codes accurately reflect the medical records and the DRG is consistent with diagnostic and procedure codes on the claims.

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Specialty Drug Cost Management

H.H.C. Group works with SmartPayRx to help curb spending on high-cost specialty prescription drugs. The program controls medical benefit and pharmacy spend through focused pre-authorization, site maximization, specialty pharmacy cost negotiation, voluntary co-pay assistance program fulfillment, and rebates.

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Workers' Compensation Services

H.H.C. Group reprices Workers' Comp claims to fee schedule and secures discounts below fee schedule on many claims. We also secure discounts from the billed charges in non-fee schedule states.

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Independent Medical Reviews

Every breed of Specialist for every type of review for claims that require an independent determination of medical necessity, causation, medical appropriateness, general acceptance, or ability to return to work, H.H.C offers internal and external independent medical reviews.

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Independent Medical Evaluations

H.H.C. Group offers high-quality Independent Medical Evaluations (IMEs) for cases requiring an examination by a doctor or other licensed healthcare professional to help answer specific legal or administrative questions related to workers' compensation or disability claims.

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No Surprise Bill Act

When you receive an unexpected, out-of-network bill for payment, H.H.C. Group can help you prepare for the future effects of the No Surprise Bill by establishing internal processes for fast assistance ahead of time.

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Functional Capacity Evaluations

H.H.C. Group also offers administration of Functional Capacity Evaluations (FCEs) used by physicians, case managers, and employers to transition injured workers from disability to function and employment.

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