Claims accuracy is the foundation of a high-value, data-directed health plan. At MAGIC Health Insurance Solutions, we prioritize precise, high-integrity claims processing and pricing to maximize value for your plan.
Medical and Pharmacy Claims Payments are Exceedingly Complex
Diagnostic Related Groupings ... lCD9 ... ICD10 ... Revenue Codes... Modifiers ... These are just a few of the thousands of variables that impact the payment of medical or pharmacy claims. From clerical errors to purposeful manipulation, this complex system is fraught with errors and your plan needs expert support. We ensure that third party administrators are accurately adjudicating your claims, holding your network accountable and ensuring the high integrity you require for high value.
Over a Trillion Dollars in Claims Analyzed
Payer-Provider network assurances aside, after years of in-depth analysis of medical and prescription claims, error rates and unreasonable disparity in claims payments is the norm. The direct increase in cost to plans and members are significant and under shareholder value. This trend must be shifted.
Accountability Starts Here
MAGIC stands on value-based healthcare and effective alignment of incentives. We earn more by ensuring our clients pay less. We are not an audit firm, and we don't focus on after-the-fact recoveries. We become your partner, working cooperatively with your third party administrators and network to reduce and eliminate the root cause of these errors.
Reconciliation and Correction over Recovery
We understand that recovery of overpayments can be contentious and create challenges with third party administrators and providers. Emphasis must be directed toward the identification of errors, correction processing on a go-forward basis and fair, equitable reconciliation for any past errors. The key being authentic partnering between the respective parties and a shared commitment to elevating integrity and increasing value.
Every Claim, Every Line, In Real-Time
Thousands of industry standards and proprietary algorithms are applied to every claim that your plan pays.
Every claim is monitored and analyzed in real-time as they are reported by your third party administrator.
Action plans are rapidly developed to address issues as they arise and avoid large complex recovery projects months or even years after a provider has been paid.
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