Partners Cost Containment Solutions provide critical insights for management of high dollar and catastrophic claims. We recognize that the highest quality of care is paramount for the best outcomes. Through early intervention and access to our preferred vendors, we can achieve excellent outcomes and optimal savings that will benefit our groups, Third-Party Administrators and carriers.

Our Solutions

Identify cost containment opportunities for involvement of specialty networks and vendors. Partners will manage and achieve optimal savings by:

• Conducting bill review and audits
• Providing Plan Document review
• Providing care oversight and determining if care meets the Summary Plan Document
• Leveraging current preferred contracts and negotiate rates
• Utilizing specialty prescription contracts for purchasing power and home infusion services

Transplants

Optimal savings can be derived from transplant contracts that covers the entire transplant process. This includes:

• The pre-transplant and transplant evaluation period
• The transplant event and the post-transplant period

We partner with national networks to provide transplant contracts with the best overall rates for our groups.

Neonate and Pre-Term Infants

Newborn and pre-term infants born with complex conditions often require extended hospitalizations and utilize high acuity care/treatments that will result in millions of dollars of care. Partners can help manage the high dollar claims by leveraging our vendors who are experienced in the following services:

• Bill Review
• Audits to identify level of care issues
• Unproven or experimental treatment
• Bill negotiations
• Providing continuous care plan oversight
• Monitoring length of stay

High Dollar Medical and Prescription Claims

We engage with our preferred vendors to achieve optimal savings for the following types of high dollar claims:

• Ventricular Assist Device (VAD)
• High dollar prescription and infusion
• Extended hospitalization
• Dialysis
• Chemotherapy
• Implants

Partners is committed to providing prompt and responsive claims service for your stop loss needs. With our highly experienced claims staff, having over 30 years of experience and a proven medical risk management department, we deliver excellent and outstanding claims service.

Our analysts are assigned to each policy account to reimburse accurately, efficiently and provide a personal touch for your claims processing needs, delivering a 15-day turnaround. ACH electronic reimbursement option is also available for immediate reimbursement needs.

Forms

• ACH Information Request Form
• Claims Guide
• Notification Form
• Claim Submission Checklist
• Eligibility Form
• Accident Questionnaire Form
• Specific Reimbursement Form
• Aggregate Reimbursement Form

For claimant 50% notices, trigger diagnosis reports, pre-certifications, high dollar notices, and large case management notes, please send to notifications@partnersmgu.com

For specific claim reimbursement requests and inquiries, please send to claims@partnersmgu.com

For aggregate year-end claims, monthly accommodations, and monthly reporting, please send to aggregate@partnersmgu.com