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Cost Plus

Cost Plus. Plan Components. Claim Process. Claim Audit Duplicate Charges Medical Necessity Claim Re-pricing Cost Plus 12% Margin or Medicare + 20% _______________________________________ Frequency 100% Cost ?. Appeals Provider Files Appeal

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Cost Plus

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  1. Cost Plus Plan Components

  2. Claim Process Claim Audit • Duplicate Charges • Medical Necessity Claim Re-pricing • Cost Plus 12% Margin or • Medicare + 20% _______________________________________ Frequency 100% Cost ? Appeals • Provider Files Appeal • Full & Fair Review By Independent Expert _________________________________________ Frequency 7% Cost ?

  3. Liability Exposure Balance Billing Law firm inserted between patient and provider. ________________________________________ Frequency 50% Cost ? Lawsuits Insurance policy indemnifies the Plan, patient, TPA and broker/consultant ________________________________________ Frequency Low Cost Retention & Premium

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