MSP Advantage®

Performant Healthcare Solutions^® offers Medicare Advantage plans a comprehensive solution suite for premium enhancement—led by eligibility experts and backed by sophisticated analytics to address:

• An estimated 4% of Medicare enrollees (2.4 million) have other primary health insurance coverage
• Member premium payments are dependent upon an accurate accounting of members with other insurance
• Untimely, inaccurate information leads to underpaid premiums, missed cost avoidance, and post-payment recoveries
• Complicated, lengthy procedures to modify CMS premium information demands dedicated plan resources and expertise to maximize bottom line impact

Our eligibility experts leverage an extensive database and proprietary algorithms to identify and validate other coverage information and accelerate premium revenue and/or Medicare Secondary Payer (MSP) program savings. Performant deploys a highly trained team of outreach professionals for manual validation of low-quality data matches and to coordinate with the MA plan, CMS, and other coverage providers. Our solution includes dedicated lockbox services offering complete end-to-end processing and accounting and integrates optical character recognition (OCR) to scan and digitize documents received by mail, maintaining a detailed account record.

As the vendor of choice for Medicare and Medicaid plans and the national CMS Commercial Repayment Center (CRC) vendor, Performant capitalizes on our expertise and established relationships with commercial and government payers, as well as healthcare providers, to provide proven, purpose-built cost containment solutions backed by transparent reporting, proprietary analytic tools, and a team of specialized industry professionals.

Payment Accuracy—identify opportunities for premium restoration utilizing sophisticated analytics, multiple sources of eligibility data, and a deep bench of analysts and outreach professionals. The payment accuracy advantage—reduce frustration with deteriorating premium dollars by restoring underpaid

Cost Avoidance—validate eligibility data and identify inaccuracies in coverage information while updating eligibility records to ensure proper payment on future claims. The cost avoidance advantage—increase confidence claims will be paid correctly, ease the burden on your team to identify and recover overpayments, and reduce the anxiety caused by provider and member abrasion

Recovery—increase MSP post-payment recoveries by employing a highly trained team of professionals with extensive knowledge of specialized recoveries. The recovery advantage—help fulfill recovery goals and ease the stress of overpaid claims and the burden on internal resources to identify and recoup overpayments.

Download our MSP Advantage product sheet to learn more.