Sample Dialysis claims showing SAVINGS! Also outlines steps to implement the program.

1. Original Bill from Dialysis Facility
Copy of Relevant Healthcare Invoice Showing Savings Results
Total Reimbursement after
Review/UCR Application:
$1,049.43
Total Savings = $12,772.61
***Provider Bills this Service 4
Times Per Month
Total Monthly Savings = $51,090.44
Total Annual Savings
=$613,085.28
Original bill from the dialysis
facility reflecting a billed charge
of $13,822.04
Over the last 12 months these
services were being reimbursed
by the TPA/Employer at 100%
of billed charges.
Dialysis Claims Settlement Program

2. Steps towards Implementing the Program
1. Secure interest through a Letter of Intent and a mutual Non-Disclosure
Agreement
2. At no cost, perform a review of the Summary Plan Document (SPD) and an
analysis of whether it supports Dialysis/Oncology claims settlement for In-
Network claims, Out-of-Network claims or both. (48 hour average
turnaround time on review)
3. Discuss results of SPD review with the client
4. Recommend any addendums or alterations to SPD language (legal
language from Phia Group supplied at no cost) to meet the needs of the
client and choose the method of review: UCR Settlement or Negotiation
with Sign-Off.
5. Finalize the SPD and create workflows with the administrator to receive
claims and return savings results
6. Client executes a Relevant Healthcare Payer Agreement and we
begin accepting/reviewing claims per the program as designed
7. Appeals Process:
a. Appeals do happen, but Relevant Healthcare is here to support the
client and manage appeals
b. Relevant Healthcare will supply the client with a detailed letter to use to
forward to the provider upon receipt of an appeal. In the case of a
balance bill, Relevant Healthcare can supply a letter in support of the
member as well
i. For Dialysis, balance billing to members does not occur –
Medicare becomes secondary and as long as reimbursement is
above Medicare, a facility cannot balance bill
c. Although only occurring less than .25% of the time, should legal
counsel be needed, Relevant Healthcare will supply the resources