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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 42% TPA 26% Health Plans 23% Unions/Other

2.1.2. $ 28 B In-Network Claims Repriced 66% Complementary 26% Primary 8% Primacy Out of Area

2.1.3. 6 M Claims reduced Out of Network 51% Negotiation 29% Data iSight 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 3,900 acute-care hospitals treat injured workers 162,000 ancillary care facilities treat injured workers 650,000 medical professionals treat injured workers

2.3.2. Auto Medical 3,100 acute-care hospitals treat auto-related injuries 109,000 ancillary care facilities treat auto-related injuries 109,000 ancillary care facilities treat auto-related injuries

3. Services

3.1. Payment Integrity

3.1.1. Complex Issues - 60% findings need physician and/or coder review to confirm Unlikely procedure combination Overlapping procedures Contradictory procedure combinations

3.1.2. Suspect Scenarios - 10% Needs physician review and may require more documentation Potentially excessive services Unusual services reported Provider profiling (e.g., physical therapist reports the same services on every bill)

3.1.3. Simple Scenarios - 30% Generally found by claim editing software, but often overlooked: Units above maximum likely levels Inappropriate use of modifiers Multiple procedure discounts Unbundling

3.2. Network Based Services

3.2.1. Participants 6,000 acute-care hospitals 200,000 ancillary care facilities 950,000 healthcare professionals

3.2.2. Types of Network National Primary PPO 4,800 primary network hospitals 94,000 primary network ancillary care facilities 797,000 primary network practitioners Select regional primary networks Complementary “wrap around” network Specialty networks

3.2.3. Customizable Networks

3.2.4. Quality and Service High throughput repricing with 98% accuracy Network contracting strategies guided by data analytics High throughput repricing with 98% accuracy Multi-channel, data-driven quality program

3.3. Analytics Based Services

3.3.1. Cost Based Pricing iSight delivers deep savings on non-contracted claims/bills

3.3.2. U&C Pricing Viant - Out of Network Facility Costs

3.3.3. Negotiated Agreements against provider balance billing 300 negotiators and support staff Turnaround in 3.2 days on average Portal and fax options for provider response and signoff