Containing costs, not care.
MagnaCare drives customer savings through in-depth clinical claim reviews by our in-house Medical Management team.
We validate claims and identify opportunities to recode claims to deliver cost savings to our clients.
Plus, our experienced nurses apply their clinical knowledge to assess medical necessity, level of service, and appropriateness of care according to policies and accepted medical standards of care. Our high-touch service includes requesting the patient’s medical chart and comparing the charges to the actual number and cost of the products and services received.
Some of our cost containment services:
DRG regrouping
Fraud and abuse detection
Quality assurance
Repricing
Post-service, post-adjudication, pre-payment review
Cost containment success story
At a leading New York City hospital, a MagnaCare member underwent outpatient knee replacement surgery. Upon investigation into the pricing, our Medical Management team uncovered an excessive markup on the price of the implant (artificial joint), which was 12 times higher than the cost to the hospital – a fee that is far beyond what is reasonable and customary.