The Right Solutions
Since 1995, HHC has delivered exceptional results through a commitment to responsiveness, integrity, and client service.
Today's healthcare environment demands more than hard work. It requires expertise, innovation, adaptability, and a thorough understanding of evolving reimbursement methodologies, regulations, coding and market dynamics. That is why HHC continually develops solutions designed to address emerging challenges and help clients manage patient's healthcare resources with confidence.
We work on behalf of government entities, healthcare providers, third-party administrators (TPAs), reinsurers, self-funded employers, health plans, and labor unions to promote accurate reimbursement, resolve complex claims issues, and support efficient, equitable healthcare payment outcomes.
Today, HHC offers a comprehensive suite of healthcare resources and claims management services, including:
Claims Negotiation and Repricing
Identifies opportunities for savings by analyzing medical claims and determining appropriate reimbursement levels based on market conditions, contracted rates, and usual and customary billing practices.
DRG Validation
Reviews Diagnosis Related Group (DRG) assignments to verify coding accuracy, clinical documentation support, and proper reimbursement for inpatient hospital claims.
Independent Dispute Resolution (IDR)
Serves as a certified Independent Dispute Resolution Entity for healthcare payment disputes between providers and health plans. HHC administers the dispute resolution process, conducts objective reviews of submitted evidence, evaluates reimbursement methodologies and market data, and issues fair, impartial, and well-reasoned payment determinations. Our experienced clinical, coding, and reimbursement professionals help ensure that disputes are resolved efficiently, transparently, and in accordance with governing regulations and established standards.
Independent Medical Evaluations (IME)
Facilitates independent medical examinations and expert assessments to evaluate diagnoses, treatment plans, disability status, causation, and return-to-work considerations.
Independent Medical Reviews (IMR)
Provides objective clinical reviews by qualified healthcare professionals to assess the medical necessity, appropriateness, and consistency of treatment with established standards of care.
Medicare Reference-Based Pricing
Uses Medicare methodologies and benchmarks to establish transparent, defensible reimbursement levels that can significantly reduce healthcare spending while maintaining provider access.
Medical Bill Review
Examines medical bills for billing errors, duplicate charges, coding inaccuracies, and unreasonable fees to ensure payment accuracy and compliance with reimbursement guidelines.
Specialty Drug Cost Management
Controls the rising costs of high-priced specialty medications through claim review, pricing analysis, utilization oversight, and alternative sourcing strategies when appropriate.
Contact HHC today to learn how our experience, technology, and proven approach can help your organization improve claim outcomes, manage healthcare spending, and navigate an increasingly complex healthcare landscape with confidence.
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