MSP Validation and Premium Restoration solution Increase revenue from MSP premiums Restore underpaid MSP premiums fast Medicare Advantage (MA) plans frequently receive incorrect primacy information from Centers for Medicare and Medicaid Services (CMS) regarding members with other coverage. Within months, this can add up to millions of dollars in underpaid Medicare Secondary Payer (MSP) premiums. It’s incumbent on MA plans to detect and correct these inaccuracies so they can restore correct premiums today and in the future. We can help. With the MSP Validation and Premium Restoration solution from Discovery Health Partners, we work on your behalf to quickly and accurately validate MSP records, correct inaccurate records, and restore underpaid premium dollars. We have designed best practices and tools that enable our team of MSP experts to: • • • • • Quickly identify a complete range of open records that require validation Capture complete validation information with 100% success Request CMS corrections through ECRS Web with 99.9% success Protect future premiums and claims payments by updating your eligibility information as necessary Create an electronic audit trail of each record to simplify compliance and revenue tracking How it works 1. Identification and prioritization: We will load your MSP and eligibility files into our Discovery Payment Integrity Platform, which uses data matching logic to quickly and accurately identify records that require validation. We compare current data files and/or outstanding MSP records to find those that indicate potential reporting or primacy discrepancies which may financially impact your premiums. 2. Validation: We validate the files and return them back to you and update any necessary systems, such as your eligibility system, as needed. Our platform includes a variety of functions and tools that improve the efficiency and success of MSP validation and ultimately lead to faster restorations. 3. CMS updates: We’ll submit ECRS transactions on your behalf to correct invalid records for premium adjustment, and we’ll manage error rate tracking and resolution. Two Pierce Place, Suite 1900, Itasca, IL 60143 │ 678.296.8918 discoveryhealthpartners.com │ [email protected] Company/Discovery-Health-Partners │ DiscoveryHealthPartners At a glance Hassle-free and Complete validation. Start to finish, Discovery Health Partners manages the data processes and the interface between providers, other payers, our team and yours. Premium restoration. Recapture more premium dollars faster when Discovery Health Partners helps you update records and restore accurate premiums. Insight through transparent reporting and analytics. Find confidence and clarity in the data supporting the validation efforts and highlight the work in progress (updates) and outcomes (dollars) for everyone to see. © 2014 Discovery Health Partners 4. Compliance and financial tracking: We’ll capture the status of MSP records each step of the way, creating an audit trail for easier CMS compliance, cross-departmental communication, and financial tracking. You’ll get full transparency throughout the process. Flexibility, partnership, and transparency When you work with Discovery Health Partners, you get a partner that is dedicated to improving your business process and your bottom line. Our team has a rich heritage of excellence in information management, consulting, and healthcare cost containment. We have a strong track record helping clients restore millions of dollars in MSP premiums in a matter of months. With this expertise, we’ll work flexibly with your team to: • Manage all or part of your MSP validation and premium restoration • Manage your process on an ongoing basis or perform the “cleanup” of all open records and then turn it over to you to manage internally using our proprietary cloud-based application • Deliver timely reporting using your preferred format and output method • Provide complete transparency throughout the process Contact us today Learn how Discovery Health Partners can help you maximize your MSP restorations. Significant potential outcomes • Our experience shows that a 30,000 member MA plan can restore an average of more than $4 million in underpaid premiums. • For a 32,000-member community health plan, we restored $8.5 million within 120 days. Ongoing savings is more than $5 million per year. • For a 30,000-member Southwestern health plan, we restored $7.1 million within 120 days. Ongoing savings total more than $4 million per year. About Discovery Health Partners Discovery Health Partners offers payment integrity solutions and analytics that help health plans and other healthcare organizations optimize revenue, improve cost avoidance, and operate more efficiently. Deep healthcare experience, combined with our strength in information management and technology, helps clients execute payment integrity processes faster, more accurately, and with trackable results. Two Pierce Place, Suite 1900, Itasca, IL 60143 │ 678.296.8918 discoveryhealthpartners.com │ [email protected] Company/Discovery-Health-Partners │ DiscoveryHealthPartners © 2014 Discovery Health Partners