United States ” Accident & Health

Maiden Re has worked with a number of industry leading claims management specialists to offer to our clients and organizations that they work with a platform of value-creating services to optimize clinical and financial outcomes for medical claims. These services include:

• Cost Containment and Consulting Services
• Hospital bill review and negotiation
• Utilization review and medical management
• Medical Case Management
• National Transplant networks
• Specialty Pharmacy management and network
• Subrogation Recovery
• Reference Based Pricing

1. Pre-claim preparation — The best way to keep claim costs low is to work with the people who control the medical Plan Documents such as Plan Administrators/TPA’s. Well written plan documents are one of the best ways to manage claims. In addition Plan Administrators/TPA’s control the initial claim management specialists used to help manage a claim. For example the Plan Administer/TPA chooses the Case Managers, Utilization Review manager, PPO’s, Transplant network, Pharmacy Benefit Managers and other specialists. Proper planning and working with the Employer, Plan Administer/TPA and Insurance Carrier can help keep quality of care high and claims cost low.   Services include:
   • Plan document review
   • Plan design
   • Stop loss contract review
   • PPO analysis
2. Claim management while the claim is active — Sometimes an Insurance Carrier/MGU is notified of a claim while it is ongoing. Plan Administers/TPA’s send out 50% notices and sometimes ask for partial reimbursement on claims that are not complete. In these situations, claim specialists have a good chance of impacting the claim. Once a notice of a claim is received, effective claim management can help respond to the needs of the patient utilizing best medical practices and effective cost control. Services include:
   • Case management
   • Utilization review
   • Optimizing claim pricing
3. Post claim review and audit — Generally Insurance Carriers/ MGU’s find out about a claim after the patient is in a facility or after the claim has been paid. This limits the ability of the Insurance Carrier/ MGU to impact the cost of the claim. There are vendors who attempt to mitigate claims that have been paid or billed. After a claim is complete, many times a claim audit and/or a review of the claim charges can result in lower claim payments. Services include:
   • Claim audit
   • Claim negotiation
   • Subrogation Recovery

Maiden Re has partnered with the following Claims Management Specialists who can assist in the types of issues describe above:

• Ethicare
• HS Technology
• Six Degrees Health
• The PHIA Group
• Corporate Benefit Audits (CBA)
• Medwatch