Health Systems International—As a TPAA member, you receive special pricing and access to our Preferred Partners, companies selected to give you a competitive edge. Health Systems International (HSI) is a leading provider in outsourced medical cost management solutions. HSI acquired Asert Benefit Services last year, adding extensive Bill Review Services to HSI's comprehensive cost saving solutions. HSI Solutions include: Network Repricing, Bill Review Services, and Specialty Services.
Network Repricing Services
Repricing is the recalculation of medical charges based on the rates and rules a PPO has negotiated through its provider agreements. HSI manages the complexities of repricing administration and data maintenance with a single gateway to more than 100 of the USA’s leading primary PPO networks. They also provide access to out-of-network and network carve-out services such as out of area services, lab, DME and dental. This allows you to configure and administer a hierarchy of networks with maximum impact on your clients’ claim dollars. For charges not repriced through a network, HSI will negotiate discounted prices on a payor’s behalf after services are rendered.
Because not all clients’ technology infrastructures are the same, HSI offers a variety of connectivity solutions including real-time web services, electronic file transfer, web entry and paper-based/imaging solutions.
Bill Review Services
Bill review and negotiation services are techniques used to review medical claims and negotiate claim costs with providers. These techniques are typically used on out-of-network claims but can also be used when additional auditing is needed on in-network medical bills. HSI/Asert bill review can be customized for clients requiring a broader spectrum of services.
Bill review services include reviews for appropriateness, integrity and validity such as correct coding, medical necessity, usual and customary charge review, pre-existing condition analysis, coordination of benefits/third party liability and recovery, case review and coordination with client’s in-house or contracted medical case review. After claims are reviewed and audited, HSI/Asert utilizes all the data to renegotiate prices based on the findings.
Specialty Carve-out Services
In addition to primary, secondary and negotiation services, HSI provides supplemental or specialty networks to generate savings on carve-out services such as specialty care in a specific area, lab services, dental services and DME.
With ancillary care becoming a growing healthcare expense concern, HSI offers Ancillary Care Services (ACS), the most comprehensive, cost effective national ancillary services network available. ACS partners with PPOs, insurance companies, self-insured employers, TPAs and union trusts to improve access to ancillary care while reducing claims costs.
HSI also offers Bridgeway Rx, a pharmacy management program with excellent service, utilization strategies and rates. Bridgeway Rx will customize and implement a plan that puts your clients in control of utilization and lowers costs.
The HSI Difference
HSI is one of the most recognized national providers in the country. They are customer focused. They have dedicated regional account managers, quality assurance professionals and experienced nurse case managers, and they offer competitive rates and customized services.
For more information on HSI, contact Joe Antonell at HSI at jantonell@us-hsi.com or 800-962-6831.
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