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THIRD PARTY MANAGEMENT
Cost-Effective Contract Enforcement

HBC knows that payers save $billions each year by systematically under
paying, arbitrarily denying and alleging not to receive physician
claims. Our third party management services can put you in control of
bargaining and enforcing contracts with managed care organizations and
integrated delivery systems.

We evaluate and select the managed care organizations that will provide
the maximum benefit to your practice. We assess the payment levels,
terms and other contract provisions that are particular to hospital- and
office-based specialty groups. On an ongoing basis, we monitor
conformity, enabling you to determine the cost and profitability of
individual contracts.
HBC Third Party Management Services
Managed Care Affiliation Strategy
dd Resource Utilization/Business Modeling
Marginal/Average Unit Cost Analysis
Physician Compensation/Productivity
Alternative Reimbursement Programs
Affiliation Guidelines/Selection Criterion
Managed Care Contract Review
dd Research Financial Viability
Ascertain References
Contract Terms and Provisions
Fee Schedule Evaluation
Capitation/Alternative Risk-based Arrangements
dd Fee-For-Service Equivalence
Adverse Selection Analysis
Case Mix
Age/Sex
Carve Out Fee-For-Service Billing
Enrollment/Member Count Verification
Investigate Local/Regional Cap Rates
Contract Negotiation
Contract Enforcement
dd Contract Matrixes
Auditing and Monitoring
Open Claims Tracking
Accounts Receivable Ratios
Delinquency Reporting
Level of Contractual Adjustments
Enrollment Verification
Utilization/ Case Mix
Contract Re-Negotiation

The HBC Difference

• Structured approach to plan participation
• Comprehensive data for better business decisions
• In-depth payer-specific open claims tracking and reporting
• Monitoring of denials and underpayment of claims
• Direct intervention when payers do not comply with contracts