2. Situation
By design, the TPA approach is highly flexible.
Program components can be replaced
without disrupting the whole –
AmeriVeri CR is a perfect “Plug and Play” Partner.
TPAs experience frustration to provide “Discount
Proof”
equal to or better than BUCA discounts.
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3. Strategies
1. Offset BUCA Discounts
Maximize medical coding accuracy
1. Reduce Health Plan Costs
Create savings on behalf of TPA and Employer
1. Market to Employers
Enhance sales by providing unique product
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4. Solution
AmeriVeri CR finds an average of 4%
additional savings after all verification
methods currently in place.
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5. Partnership
AmeriVeri CR works with you:
– On behalf of the Self-Funded Employer
– To maximize coding accuracy
– And find additional savings
TPA
Provider
Employer
AmeriVeri CRAmeriVeri CR
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6. Code Verification
• AmeriVeri CR system databases updated as
changes to the code occur
• Proprietary software verifies:
• AmeriVeri CR does not verify Benefits
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TPAs generally provide much better reporting than BUCA; more flexible
with more detail. AmeriVeri CR enhances reporting.
7. About AmeriVeri CR
AmeriVeri CR is accountable
– TAT (quick turn around time)
– Quality of service/producer
– Problem resolution
It is OK to brand the AV CR program as
TPA or Employer, or to blind market.
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8. Technology
• SAS70 Type II Certified
– Secure hosting facility and redundancy
• HIPAA Compliant
– All policies and procedures
• Cloud Hosted Virtual Servers
– Scalable platform for high capacity processing
– Recently processed 975k claims in under 22 minutes
• Data Transfer via SFTP
– File feeds scheduled at convenience of TPA
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9. “Plug & Play” Solution
Claims Adjudicated by
TPA
Claims Prepared for
Final Processing
TPA Completes Claims
Processing
AmeriVeri CR Identifies
Savings
Batch Returned to TPA
AmeriVeri CR
YES
NO
Steps 1-3 represent current process
Steps 2a-2b represent AVCR process
1
2
3 2b
2a
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10. Savings Distribution
• AmeriVeri CR identifies code errors after all
current verification methods
• Identified Savings Distribution:
• 75% to the Client
• 25% to AmeriVeri CR
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11. Verification Example
• Annual Claims Processed $200,000,000
• AmeriVeri CR Savings @4% $ 8,000,000
• 25% to AmeriVeri CR $ 2,000,000
– Includes all processing, service, and appeals
• 75% to Client $ 6,000,000
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12. Next Steps
1. Configuration Meeting
– Review and execute agreements
– Introduce IT managers
1. Activate AmeriVeri CR Program
– Schedule date to begin service
1. Create Savings
No Cost to Test or Initiate Service
All forms and agreements provided for review
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