Coalition America, Inc.

In an effort to improve further the company’s cost containment services, Coalition America (CAI) recently restructured its Negotiations Department and tapped Dr. David Rearick to oversee its’ operations. Dr. Rearick, who also serves as the company’s Medical Director, will supervise the enhanced negotiation and workflow processes and its hiring and training programs. As a former provider and medical director of a large insurance company, Dr. Rearick is uniquely qualified to bring fresh insight and expertise to this department.

Through its Negotiations Department, Coalition America provides significant savings for its clients by securing substantial discounts on out-of-network claims. The company has restructured its negotiations processes to include:

Out-of-network claims over $5,000 are personally negotiated with discount offers benchmarked against established UCR and Medicare reimbursements;
Claims under $5,000 follow an established negotiation process where providers are given the choice of accepting an individual discount, discounting all CAI patients "en masse," or contacting CAI to negotiate their own discount;
On claims more than $10,000, CAI will contact clients directly and can usually negotiate higher discounts if they receive a fax copy of entire claim, an itemized bill, and all ICD-9 and procedure codes appropriately noted;
Ability to do DRG validation to check if the diagnosis and procedures support the charges;
Pre-negotiation of potential high dollar out-of-network bills that are usually easier to negotiate before the patient is treated.

"Our negotiations capabilities are one of the full-service cost containment strengths of our company," notes Dr. David Rearick. "Not only do we to supplementally reprice out-of-network claims, we will negotiate further discounts when possible, delivering two cost containment solutions to our clients."

###