Pinnacle Preferred Solutions has in-depth expertise and significant years of experience regarding analytics, modeling (both industry and like specialty), re-pricing and contract negotiations. By applying our proprietary methodology combined with technology and expertise, we will be able to assist you and deliver superior results that will provide for increased revenues. This methodology will allow our clients to achieve success beyond traditional industry standards as well as provide for thorough knowledge transfer to ensure your own team members can replicate process details.
Contract Modeling
Pinnacle Preferred Solutions has in-depth expertise and significant years of experience regarding analytics, modeling (both industry and like specialty), re-pricing and contract negotiations. By applying our proprietary methodology combined with technology and expertise, we will be able to assist you and deliver superior results that will provide for increased revenues. This methodology will allow our clients to achieve success beyond traditional industry standards as well as provide for thorough knowledge transfer to ensure your own team members can replicate process details.
Contract Negotiations
The contracts a provider has executed are the cornerstone to their success. Protection of an organization’s interests during the contract negotiation is critical to maximize the benefit value to your operations. We provide a thorough contract review and help our clients develop and understand the detailed language and application of terms of the final contract. In addition, we work closely with the client’s legal counsel to define business and financial issues and develop the negotiation strategy. We have negotiated systems for many organizations, hospitals, physicians, and other health care facilities.
Historical Claims Payment Assessment
Pinnacle Preferred Solutions will perform a historical payment analysis, identify potential recovery opportunities and complete an evaluation to improve contractual language to minimize the underpayment error potential. We provide a thorough contract historical assessment, identify patient level detail potential recoveries and recommend possible improvements with specific payor contracts.
Pinnacle Preferred Solutions provides various solutions to assist self-insured employers’ with maximizing their program in today’s complex health-care environment. With our team of health-care leaders and vast experience, we can assist employers in reducing costs, improving programs, and delivering a comprehensive benefits program for their employees. In additional to the services outlined, we can discussed individual needs and create a program that is customized specifically for an employer.
Benchmark Reporting
Our benchmark and comparison reporting will assist in revealing opportunities for future negotiations to maximize value for our clients. Utilizing our proprietary system, Pinnacle Preferred Solutions can provide detailed reporting to better understand your current benefits program and provide data to maximize the objectives for the future. Our understanding of the evolving delivery of healthcare services, combined with insight into the industry’s creative benefit design, helps in developing a completely integrated approach to meet both immediate and long-term objectives.
Claims Auditing
A thorough understanding of our clients’ health care benefits, combined with our knowledge of benefit offerings, enables us to work with the Third Party Administrator to help ensure your claims are processed in accordance to the coverage outlined in your Summary Plan Document (SPD). Our professionals use state-of-the-art technology to validate all claims are processed correctly and accurately. We can conduct review sessions on numerous TPA transaction vendors and analyze various benefit categories as they relate to your specific benefits.
Network Re-Pricing
We help our clients optimize the return on their health care benefit line item detail. We provide services in the identification of allowables, then communicate the correct amounts to your TPA thereby ensuring accurate data capture and elimination of your reliance on a TPA’s ability to provide accurate data and reporting for future analysis.
Contract Negotiations
Protection of an organization’s interests during the contract negotiation with providers within your network is critical to maximize the benefit value to your employees and your company. We provide a thorough contract review and help our clients develop and understand the detailed language and application of terms of the final contract. In addition, we work closely with the client’s legal counsel to define business and financial issues and develop the negotiation strategy. We have negotiated systems for many organizations, hospitals, physicians, and other health care facilities.
Benefit Modeling
An organization’s ability to model various benefit scenarios to accurately predict benefit refinements in the most effective and efficient manner is invaluable in today’s healthcare environment. Our comprehensive benefit modeling services go far beyond basic review and can assist in securing the best stop loss levels to minimize risk exposure. We work with our clients to specify stop loss design, benefit designs and contribution levels.
Historical Claims Payment Assessment
Pinnacle Preferred Solutions will perform a historical payment analysis, identify potential recovery opportunities and complete an evaluation to improve contractual language to minimize the overpayment error potential. We provide a thorough contract historical assessment, identify member level detail potential recoveries and recommend possible improvements with specific provider contracts. Area of focus include; Implant contractual recoveries, contract language refinement opportunities, contract renewal timeframe, length of stay benchmarks, facility benchmarks, and utilization redirection advice.
Utilizing our vast experience and sophistic systems, Pinnacle Preferred Solutions can partner with brokers and consultants to assist with complex reporting and analysis. The services provided can maximize the overall value a broker / consultant provides to their client and provides an opportunity to create a benefits program to meet today’s health-care challenges. In addition to the services provided, we are available to create a customized product to meet your specific needs.
Benchmark Reporting
Our benchmark and comparison reporting will assist in revealing opportunities for future negotiations to maximize value for your clients. Utilizing our proprietary system, Pinnacle Preferred Solutions can provide detailed reporting to better understand your clients current benefits program and provide data to maximize the objectives for the future. Our understanding of the evolving delivery of healthcare services, combined with insight into the industry’s creative benefit design, helps in developing a completely integrated approach to meet both immediate and long-term objectives.
Contract Modeling
Pinnacle Preferred Solutions has in-depth expertise and significant years of experience regarding analytics, modeling, re-pricing and contract negotiations. By applying our proprietary methodology combined with technology and expertise, we will be able to indentify the best options for your clients as you evaluate various network opportunities.
Network Evaluation
Pinnacle Preferred Solutions provides services in network performance. Specific contracts or complete networks can be compared to determine the best solution for a self-insured employer. Utilizing sophisticated systems, the analysis performed will identify the areas of strength and weakness within specific contracts. This information is invaluable for the employer to better maximize the performance of their self-insured benefits program.
Claims Auditing
Pinnacle Preferred Solution’s thorough understanding of employers health care benefits, combined with our knowledge of benefit offerings, enables us to work with the Third Party Administrators to help ensure claims are processed in accordance to the provider contracts in place and the Summary Plan Document (SPD). Our professionals use state-of-the-art technology to validate all claims are processed correctly and accurately. We can conduct review sessions on numerous transaction vendors and analyze various benefit categories as they relate to the specific needs of the client.
Benefit Modeling
Pinnacle Preferred Solutions can model various benefit scenarios to accurately predict benefit refinements in the most effective and efficient manner. Our comprehensive benefit modeling services go far beyond basic review and can assist in securing the best stop loss levels to minimize risk exposure. We work with our brokers and consultants to perform numerous “what if” scenarios to better understand their clients benefits program and make recommendations for future optimization.
Historical Claims Payment Assessment
Pinnacle Preferred Solutions will perform a historical payment analysis, identify potential recovery opportunities and complete an evaluation to improve contractual language to minimize the overpayment error potential. We provide a thorough contract historical assessment, identify member level detail potential recoveries and recommend possible improvements with specific provider contracts. Area of focus include; Implant contractual recoveries, contract language refinement opportunities, contract renewal timeframe, length of stay benchmarks, facility benchmarks, and utilization redirection advice.
Pinnacle Preferred Solutions can provide various services for
Third Party Administrators, which will increase their overall
value to their clients. These services outlined, as well as customizable solutions, will increase efficiencies and maximize savings.
Benchmark Reporting
Our benchmark and comparison reporting will assist in revealing opportunities for future negotiations to maximize value for your clients. Utilizing our proprietary system, Pinnacle Preferred Solutions can provide detailed reporting to better understand your clients current benefits program and provide data to maximize the objectives for the future. Our understanding of the evolving delivery of healthcare services, combined with insight into the industry’s creative benefit design, helps in developing a completely integrated approach to meet both immediate and long-term objectives.
Claims Auditing
A thorough understanding of the current marketplace, combined with our knowledge of benefit offerings, enables us to work with the Third Party Administrators’ to help ensure your claims are processed in accordance to the coverage outlined in the employers Summary Plan Document (SPD). Our professionals use state-of-the-art technology to validate all claims are processed correctly and accurately. We can conduct review sessions on numerous TPA transaction systems and analyze various benefit categories as they relate to your specific areas of focus.
Benefit Modeling
An organization’s ability to model various benefit scenarios to accurately predict benefit refinements in the most effective and efficient manner is invaluable in today’s healthcare environment. Our comprehensive benefit modeling services go far beyond basic review and can assist in securing the best stop loss levels to minimize risk exposure. We work with our clients to specify stop loss design, benefit designs and contribution levels.
Historical Claims Payment Assessment
Pinnacle Preferred Solutions will perform a historical payment analysis, identify potential recovery opportunities and complete an evaluation to improve contractual language to minimize the overpayment error potential. We provide a thorough contract historical assessment, identify member level detail potential recoveries and recommend possible improvements with specific provider contracts. Area of focus include; Implant contractual recoveries, contract language refinement opportunities, contract renewal timeframe, length of stay benchmarks, facility benchmarks, and utilization redirection advice.
