LATIN AMERICA SERVICES

HealthClaim Solutions® provides full service medical review and hospital/facility audit for healthcare payers and administrators. A large national panel of specialist MDs from over 125 specialties and subspecialties provide medical necessity opinions, medical and surgical pre-certification, claim/coding review, quality assurance peer review, fraud and abuse analysis, Medicare and Medicaid review, behavioral health review, disability and workers' comp review, with coding, claims and bill audit in all areas. Our consultants have a national geographic base. Disability file review is performed for both disability firms as well as ERISA plans. Post payment audits and Medicare and Medicaid audits are also key product areas.

In addition to our core area of medical review, HealthClaim Solutions® has distinguished itself as an industry leader for hospital and facility bill audit. In-house physician specialists differentiate us from traditional bill review and claims audit firms. Our fees are flat rate or hourly and are not contingency-based. Hospital inpatient bills of all sizes are reviewed both in-network and out of network. Physician specialist and line charge audits are commonly performed in network where 95% of today's hospitalizations occur.

We have a group of dedicated claims, coding, and repricing professionals onsite at our main office in Orange County, CA as well a large national panel of physician and other medical specialists.

We serve all health insurance payer markets including ERISA plans, Third Party Administrators, UM/CM, care management, cost containment companies, Blues plans, Medicare Advantage, Medicaid plans, managed general underwriters, stop loss and reinsurers, and disability and workers' comp carriers.