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HealthClaim Solutions ® provides full service medical review and hospital/facility audit for healthcare payers and administrators. A large national panel of specialist MDs from over 125 specialties and subspecialties provide medical necessity opinions, medical and surgical pre-certification, claim/coding review, quality assurance peer review, fraud and abuse analysis, Medicare and Medicaid
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James M. Considine, MD, MBA, CEO, President Phone: 1-800-376-6522 Email: [email protected] Sales & Marketing Phone: 1-866-716-1174 Email: [email protected] Front Office and MIS Technical Support Front Office (Scott Swanson, Olivia Tran) Phone: 1-800-376-6522 [email protected]
HealthClaim Solutions® Medical Review utilizes specialist knowledge of board certified and practicing physician specialists from a panel covering more than 125 medical, allied health and dental specialties and subspecialties. An additional component to our medical review service is the application of correct coding and billing expertise by certified medical coders.
The medical stop loss captive is uniquely positioned between the primary payer and stop loss carrier. A central challenge for the medical stop loss captive and its owner, will be the reality of high dollar hospital bills exceeding the primary payer level and not reaching the stop loss threshold.
Approximately 95% of hospital admissions are in-network. Therefore, it is essential that primary and stop-loss payers have the right tools to navigate the complex demands of the in-network environment to affect the best financial and quality outcomes for special cases.
This website is for the exclusive use of Considine & Associates employees, authorized medical consultants and customer/clients. This computer and network system, including all related hardware and software equipment, including internet access are provided only for authorized use by Considine & Associates employees, authorized medical
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