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Multiplan by Mind Map: Multiplan

1. Org Facts

1.1. 22 Offices

1.2. 2000 Employees

1.3. 60 M Members access their Services

1.4. $900 M Revenue

2. Markets

2.1. Commerical

2.1.1. 700 Clients

2.1.1.1. 42% TPA

2.1.1.2. 26% Health Plans

2.1.1.3. 23% Unions/Other

2.1.2. $ 28 B In-Network Claims Repriced

2.1.2.1. 66% Complementary

2.1.2.2. 26% Primary

2.1.2.3. 8% Primacy Out of Area

2.1.3. 6 M Claims reduced Out of Network

2.1.3.1. 51% Negotiation

2.1.3.2. 29% Data iSight

2.1.3.3. 21% Viant Facility U&C

2.2. Government

2.2.1. Medicaid and CHIP Medicare and Medicare Advantage Veterans Administration TRICARE Federal and State Agencies

2.3. P&C

2.3.1. Worker's Compensation

2.3.1.1. 3,900 acute-care hospitals treat injured workers

2.3.1.2. 162,000 ancillary care facilities treat injured workers

2.3.1.3. 650,000 medical professionals treat injured workers

2.3.2. Auto Medical

2.3.2.1. 3,100 acute-care hospitals treat auto-related injuries

2.3.2.2. 109,000 ancillary care facilities treat auto-related injuries

2.3.2.3. 109,000 ancillary care facilities treat auto-related injuries

3. Services

3.1. Payment Integrity

3.1.1. Complex Issues - 60%

3.1.1.1. findings need physician and/or coder review to confirm

3.1.1.1.1. Unlikely procedure combination

3.1.1.1.2. Overlapping procedures

3.1.1.1.3. Contradictory procedure combinations

3.1.2. Suspect Scenarios - 10%

3.1.2.1. Needs physician review and may require more documentation

3.1.2.1.1. Potentially excessive services

3.1.2.1.2. Unusual services reported

3.1.2.1.3. Provider profiling (e.g., physical therapist reports the same services on every bill)

3.1.3. Simple Scenarios - 30%

3.1.3.1. Generally found by claim editing software, but often overlooked:

3.1.3.1.1. Units above maximum likely levels

3.1.3.1.2. Inappropriate use of modifiers

3.1.3.1.3. Multiple procedure discounts

3.1.3.1.4. Unbundling

3.2. Network Based Services

3.2.1. Participants

3.2.1.1. 6,000 acute-care hospitals

3.2.1.2. 200,000 ancillary care facilities

3.2.1.3. 950,000 healthcare professionals

3.2.2. Types of Network

3.2.2.1. National Primary PPO

3.2.2.1.1. 4,800 primary network hospitals

3.2.2.1.2. 94,000 primary network ancillary care facilities

3.2.2.1.3. 797,000 primary network practitioners

3.2.2.2. Select regional primary networks

3.2.2.3. Complementary “wrap around” network

3.2.2.4. Specialty networks

3.2.3. Customizable Networks

3.2.4. Quality and Service

3.2.4.1. High throughput repricing with 98% accuracy

3.2.4.2. Network contracting strategies guided by data analytics

3.2.4.3. High throughput repricing with 98% accuracy

3.2.4.4. Multi-channel, data-driven quality program

3.3. Analytics Based Services

3.3.1. Cost Based Pricing

3.3.1.1. iSight delivers deep savings on non-contracted claims/bills

3.3.2. U&C Pricing

3.3.2.1. Viant - Out of Network Facility Costs

3.3.3. Negotiated Agreements

3.3.3.1. against provider balance billing

3.3.3.1.1. 300 negotiators and support staff

3.3.3.1.2. Turnaround in 3.2 days on average

3.3.3.1.3. Portal and fax options for provider response and signoff