In the world of health insurance, accurate claims processing and pricing are paramount for maintaining high-value, data-directed health plans. MAGIC Health Insurance Solutions makes it their mission to ensure your plan operates with the highest levels of accuracy and integrity, so you don’t overpay for medical and pharmacy claims.
Medical and Pharmacy Claims Processing: A Complex System
Medical and pharmacy claims payments are notoriously complex, involving thousands of variables like Diagnostic Related Groupings (DRGs), ICD9 and ICD10 codes, revenue codes, and modifiers. These complexities mean that errors—whether clerical mistakes or purposeful adjustments—can often lead to inflated costs for your health plan.
At MAGIC, we ensure that every third-party administrator (TPA) accurately processes your claims, holding networks accountable so you can be confident in the integrity of every payment made. For us, it’s about high-value coverage at its most accurate.
Analyzing Over a Trillion Dollars in Claims to Minimize Error Rates
Despite assurances from payer-provider networks, years of claims data analysis reveal a high rate of errors and disparities in claims payments. These inaccuracies drive up costs for both plan sponsors and members. Through continuous monitoring and proactive adjustment, MAGIC Health Insurance Solutions is reshaping this trend by reducing error rates and improving overall cost efficiency.
Accountability at the Core
At MAGIC, our focus is on value-based healthcare and aligned incentives. Instead of taking a traditional audit approach, we partner directly with your TPAs and networks to target the root causes of payment errors. This approach means your costs go down, not through after-the-fact recoveries but through real-time accuracy and collaboration.
Prioritizing Reconciliation Over Recovery
Overpayment recovery can often cause friction between plan sponsors, TPAs, and providers. Our approach emphasizes the identification and correction of errors as they arise, with a strong focus on equitable reconciliation. This method fosters an authentic partnership across all parties, with a shared commitment to high-integrity claims processing.
Real-Time Analysis of Every Claim, Every Line
To maintain accuracy, MAGIC applies thousands of industry standards and proprietary algorithms to each claim, tracking every line in real-time as reported by your TPA. By analyzing claims as they’re submitted, we address any issues on the spot, avoiding the need for complex recovery projects months or years down the line.
Partner with MAGIC for Claims Accuracy
If you’re looking for a data-directed approach to health plan management with real-time claims accuracy, MAGIC Health Insurance Solutions is your partner. Our proactive approach ensures every claim is processed accurately, helping reduce costs and increase value for both employers and employees.
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