UHAS has substantial consulting experience related to analytical and actuarial services for hospitals, physician groups, other providers, provider networks, provider-owned health plans, and managed care organizations.
Network/Provider Actuarial Services Offered:
- Reimbursement amounts and benchmarking;
- Designing and pricing provider networks (e.g., HMO’s, ACO’s, PPO’s, “Narrow” Networks, Primary Care Medical Homes, High Performance);
- Creating fee schedules;
- Analyzing provider contract terms and assisting with negotiations;
- Developing capitation rates;
- Evaluating stop loss coverages;
- Analyzing and mining claims data;
- Assisting with ASO provider network related bid responses (network discounts, disruption, and claims re-pricing);
- Other related consulting services (e.g., risk adjustment, product pricing, and rate filings).
We provide services for public and private entities in support of multiple coverage types: large group, small group, individual on- and off-exchange, fully-insured, and self-insured.
Our team is uniquely qualified and has proprietary models to support providers, provider networks, health plans, TPA’s, and underwriters with practical solutions to evaluate a multitude of provider-payer partnerships as well as to assess strategies as these organizations adapt to the ever-changing healthcare environment.
Contact us to learn more about our network/provider services.