Client Update
EMPLOYEE
Patty Kreuzer
Sr. Claims Examiner III Employee since: 8/19/2010 Education: Bryant & Stratton
My Strengths:
• Helping others • Independent
Best Part of Working at UCS:
The company as a whole is like my second family. We all work together and get the job done - no matter what.
What would someone find you doing on a weekend?
Taking a drive to explore Arizona - especially the mountains. I can’t get enough... they are awesome!
Do you collect anything interesting? If so, what & why?
I collect angels. They remind me of my mom.
Favorite food & beverage?
Buffalo Chicken Wings with Blue Cheese & Captain Morgan!
SPOTLIGHT Do you have any pets?
Reggie - my Old English Bull Dog
Who is your role model & why?
My dad has worked so hard to give all six of us what we needed. My dad only had a sixth grade education before he had to go to work to help his family. He is still very independent at the age of 92.
What is your greatest accomplishment?
Being a mom to my four children, watching them grow & being the best.
What is your biggest regret?
Moving so far away from family.
What major goal do you hope to accomplish someday?
My daughter runs the marathons at Disney. My goal would be to someday join her!
Favorite TV shows/movies:
• This is Us • Dirty Dancing
Things people do not know about you that you wish they did:
I am fortunate enough to work for a company that is allowing me to work remotely. I will be moving to Ocala, Florida at the end of October to be near half of my family. At least I will be on the same coast as all of them!
My family includes:
• Three brothers & two sisters • Two daughters & two sons • A beautiful granddaughter
Last thing you bought online:
Gifts for my granddaughter!
t i d e s s i m u o y e s a c In Great Point Partners-Backed United Claim Solutions Completes Acquisition of INETICO August 16, 2017 GREENWICH, CT and PHOENIX, AZ - Great Point Partners (“GPP”) today announced that United Claim Solutions (“UCS”), a GPP II portfolio company, has acquired Tampa, Florida-based INETICO. INETICO focuses on providing health care cost containment services to self-funded, third party administrator (“TPA”) and stop-loss clients across the United States and Puerto Rico. The addition of INETICO brings additional resources and capabilities to UCS and will augment its suite of payment integrity solutions. “UCS’ acquisition of INETICO expands our service offering and further deepens our commitment to the highest level of customer service when addressing our clients’ needs,” Josh Carder, CEO of UCS, stated. “The addition of INETICO brings us a great team, led by Founder, CEO, and industry veteran, Joe Hodges. Joe has a record of exceptional service, products and quality in the payment integrity industry.” “UCS and INETICO joining forces will help drive innovation in the payment integrity market. The addition of INETICO will add care management and new repricing services to UCS, and will help UCS continue to drive down health care costs for our clients,” added Noah Rhodes, Managing Director at Great Point Partners. “We believe that together, our two companies will create a leader in payment integrity solutions. Our goal is to work with our self-insured, TPA and stop-loss clients to create a one-stop shop for their cost containment needs. UCS’ savings rates and innovative solutions combined with INETICO’s care and negotiation services will be a driving force in the industry,” commented Joe Hodges, Founder of INETICO. In conjunction with this acquisition announcement, UCS is also unveiling NX Health Network, its high-performance custom network solution for self-insured groups that reduces medical costs and increases patient and provider satisfaction. For more information on NX Health Network, please visit http://www.nxhealthnetwork.com/ or call (800) 834-2312.
About Great Point Partners
Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading health care investment firm with approximately $1 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. GPP is currently making new private equity investments from GPP II, a $215 million fund. Great Point Partners manages capital in private (GPP I, $156 million and GPP II, $215 million) and public (BioMedical Value Fund, approximately $600 million) equity funds. Great Point Partners has provided growth equity, growth recapitalization and management buyout financing to more than 100 growing health care companies. The private equity funds invest across all sectors of the health care industry with particular emphasis on biopharmaceutical services and supplies, services, outsourcing, pharmaceutical infrastructure and information technology enabled businesses. The firm pursues a proactive and proprietary approach to sourcing investments and tuck-in acquisitions for its portfolio companies. For further information, please contact Great Point Partners at (203) 971-3300 or www.gppfunds.com.
Learn More about the UCS Family of Companies
INETICO understands that the rising cost of healthcare effects everyone - from insurer to provider, right down to the plan member. Increased healthcare costs can potentially paralyze an insurer or an employer group’s ability to provide reasonably priced coverage. INETICO’s suite of solutions for payers reduces operating expenses by streamlining the claims process and network repricing functions. By generating significant cost containment for critical and catastrophic claims through URAC accredited and focused care, we can provide disease management and proactive wellness initiatives. INETICARE, the Care Management division of INETICO, provides a comprehensive suite of services. Through INETIPASS, our web-based Care and Claims Management system, clients have access to up-to-the-minute information regarding their claims and care management activity, which provides 100% transparency. INETICO’s philosophy is to bring IMAGINATION, INNOVATION and INTEGRATION into the healthcare market, which aligned perfectly with UCS’s mission.
High Performance, High Value PPO Network
Specifically Designed for the Self-Funded Market Built based on the exact needs of your organization. We work with you to ensure the right providers are innetwork & those agreements are based on a Percentage of Medicare to provide increased savings & flexibility.
Built and founded specifically for the self-funded market. You do healthcare differently – we make it easy!
Our highly qualified providers undergo rigorous credentialing using NCQA accreditation standards.
Battle rising healthcare costs by building your network with providers who are the best fit.
With our Provider Locator, you can search for a provider or hospital in your area by specialty, education & more!
Save 20% - 30% more than traditional PPOs based on our network contracting methodologies and claim repricing processes.
Suanne DeClue
Director of Contracting & Network Development My name is Suanne DeClue. I was born and raised in Lubbock Texas. I grew up on a working farm. I am one of 5 children. I learned very early that work ethic is everything, and I was raised to understand that you achieve nothing in this life if you are not willing to work for it. One of the greatest things my parents did for me was at age 11 - they began giving me a small percentage of the money that we earned from the cotton and grain we grew. I received about $350.00, and I had to make that last for the entire year. I had to save for things I knew I wanted to do later in the year, or I would not be able to attend. It helped me a lot when I suddenly found myself raising 4 daughters alone. I also have 5 grandchildren – two of them live with me. I have worked in the health care administration field since I graduated high school. I have worked as the receptionist, member service representative, admin assistant, prior authorization coordinator, grievance and appeals coordinator, claims research and resolution coordinator, member services manager, provider relations representative, contracting coordinator, contract negotiator, grant writer, provider relations manager, contracts and network development manager, contracts administrator, and now director of contracting and network development. It has been a wild ride, but worth every minute. I am a huge fan of Professional football, and raised in Texas -YES- you guessed it, I am a Dallas Cowboys Fan. Once Football Season is here, I have the Sunday Ticket with Direct TV, and my house on Sundays is filled with friends, family, food, and FOOTBALL – non-stop. We are always sad when the season ends. I am very pleased to be working here at United Claim Solutions / NX Health Network. I am thankful to Jordan for giving me this opportunity, and blessing me with a great staff (Jorge and Brain). I look forward to getting to know all of you.
Marissa Mercado Claims Editing Analyst
I was born and raised in Phoenix but moved to California my senior year of high school. I graduated with honors and went to California State University Los Angeles where I studied Psychology. I just moved back to Phoenix 2 years ago and began working in the healthcare field shortly after. I was hired as an intern at my previous job where I worked on behalf of different providers doing collections and billing while working with commercial payers. I eventually was offered a full time position and worked there for the previous 10 months before coming to UCS. I teach dance in the evenings part-time at the dance studio I grew up dancing at. I am the oldest of 6 (4 sisters and 1 brother) and I am extremely close with each and every one of my siblings. I also have two dogs that I completely adore. I’m very excited to be a part of UCS and to further my knowledge in this field!
Solution Showcase
Medical Implant Solution Powered by United Claim Solutions is pleased to announce that our newest Cost Management Solution is designed to effectively limit plan liability for Medical/Surgical Implants. This solution offers our clients the ability to reprice implants with laser-like focus, and dramatically reduce the cost of such items.
The Challenge Absence of UCR data makes it difficult to determine reasonable price Providers charging up to 9,000% of acquisition costs Securing legitimate invoices is met with resistance and avoidance from providers Plan Document language often fails to protect the Health Plan upon appeal
UCS Implant Solution
For In-Network & Out-of-Network Claims!
Offers a reasonable mark-up over cost as specified by Plan Document language at ER Group level UCS funded drafting of effective & clear Master Plan Document language Applications for both in-network and out-of-network claims
UCS Data
Offered at a % of Savings!
Our unique collection of medical implant data includes the following:
240,000+ Unique Implants
374
Implant Categories
700,000+ 555,000 4,800+ Price Ranges
Implant Price Points
Implant Vendors
3,100+ Reporting Facilities
GAIN A BETTER UNDERSTANDING OF...
Prostate Cancer What is the prostate?
The prostate is a small gland of the male reproductive system resting below the bladder in front of the rectum and surrounding part of the urethra. It helps to produce the fluid in semen and is normally the size of a walnut.
Besides skin cancer, prostate cancer is the most common malignancy in men. Statistics show that annually, worldwide, approximately 1.1 million men are diagnozed with prostate cancer and more than 300,000 die from it. Although prostate cancer can potentially grow and spread quickly, it usually grows slowly or not at all. According to the Prostate Cancer Treatment Research Foundation (PCTRF), many men have no symptons related to their prostate cancer. If there are symptoms, they may include: • Urinary problems such as weak urine stream, difficulty urinating, stopping & starting during urination and pain and/or burnng with urination. • Blood in the urine and/or semen • Discomfort or pain during ejaculation • Pain in the hips, pelvis, back or upper legs
Who is at a higher risk?
• Over 65 years of age • Family History of prostate cancer • Race • Certain Prostate Changes • Certain Genome Charges
Common Screening & Controversy
It’s the best to screen for and detect cancer early before there are symptoms. According to the Centers for Disease Control and Prevention (CDC), two tests are commonly used to screen for prostate cancer: • Digital rectal exam (DRE): a gloved, lubricated finger is inserted into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities. • Prostate-specific antigen: The PSA level is measured in the blood. PSA is made by the prostate, and the levels of PSA in blood can be higher in men who have prostate cancer. Generally, the higher the PSA level in the blood, the more likely a prostate problem is present. Besides prostate cancer, other factors that can affect the PSA level are certain medical procedures, some medications, an enlarged prostate and prostate infection. The PSA test may have false positive or false negative results, which means men may think they have cancer when they do not, or they may have cancer and the PSA test missed it. The American Cancer Society (ACS) advises men 50 and older to talk with their physician about whether to test for prostate cancer. Men with one or more risk factors should consult a doctor about whether to begin screenings earier. When having a screening dicussion, decision aids and provisions should be documented in the medical record, particularly when the patient decides against screening.
Treatment Options are Based on Stages
There are plenty of treatment options for prostate cancer. Many factors weigh into treatment, including the stage of the disease (stages 1-4), age and health. Tests to help determine the stage of prostate cancer include: • Transrectal ultrasound • Magnetic resonance imaging (MRI) of the prostate using a rectal probe • Computed tomography scan of the abdomen and pelvis to look for prostate cancer metastasis to other organs • MRI of the skeleton or a nuclear medicine bone scan to look for bone metastasis • Surgery to examine the lymph nodes in the pelvis for spread prostate cancer
Prostate options for treatment are dependent on the stage and may include:
• Active Surveillance • Advanced Prostate Cancer Treatment (endocrine therapy, chemotherapy & Provenge) • Alternative Treatments (herbs & dietary supplements) • Cryotherapy (freezing the abnormal cells to destroy cancerous tissue) • High-intensity focused ultrasound (sound waves directed to destroy the cancer cells) • Hormone Therapy (androgen deprivation therapy or androgen suppression therapy) • Laparoscopic Surgery (a scope inserted into the abdomen while minimally invasive surgery removes tissue) • Radical Prostatectomy (operation to remove the prostate gland & tissue surrounding it) • Radiation Therapy (high doses of radiation, such as X-rays, to destroy cancer cells; proton beam therapy; placing radioactive seeds around the tumor)
Becoming Familiar with Clinical Lingo
Make deciphering clinical documentation easier by recognizing common medical terms, abbreviations and acronyms. Below is prostate cancer-related terminology, abbreviated as you may see them in physician documentation. ADT ................................... Androgen deprivation therapy BPH ................................... Benign prostatic hyperplasia CAB .................................. Complete androgen blockade CaP ................................... Cancer of the Prostate DART ................................ Dynamic adaptive radiation therapy EBRT .................................External beam radiation therapy FLA ................................... Focal laser ablation GnRH ............................... Gonadotropin-releasing hormone HB .................................... Hormone blockade HDK ................................. High dose ketoconazole IADT ................................. Intermittent androgen deprivation therapy Keto ................................. Ketoconazole LHRH ............................... Luteinizing hormone-releasing hormone LRP .................................. Laproscopic radical prostatectomy M0-M1 .............................. Status of cancer metastasis NSE .................................. Neuron-specific enolase ORCH ............................... Orchiectomy (testical removal) PAP .................................. Prostatic acid phosphatase RPP .................................. Radical perineal prostatectomy SVI ................................... Seminal vesicle invasion TRUS ............................... Transrectal ultrasound WPRT .............................. Whole pelvic radiation therapy XRT .................................. External radiation therapy
Article from www.aapc.com September 2017
EMPLOYEE BIRTHDAYS: September 5: Linda Myrick, Edit & Special Projects Manager September 20: Amanda Hertig, Corporate Marketing & Recruitment September 21: Eric Hanna, Implementation Manager September 22: Ryan O’Mahoney, VP Operations September 23: Josh Perkins, Controller
ANNIVERSARIES: September 14: Amanda Hertig, Corporate Marketing & Recruitment............ 2 Years
AUGUST CLIENT CONTEST WINNER: Question: Approximately how many yellow school buses transport children to & from school every weekday in the USA?
Answer: 480,000 Drawing Winner:
Carol Hopper ........................................ $50 VISA Gift Card
Thank you everyone for your participation!
FALL TRIVIA QUESTION:
Which state is warmest during the fall & which state is coolest during the fall? A.
Arizona Maine
B.
California Vermont
C.
Florida Alaska
Those that answer the question correctly will be entered into a drawing for a $50 VISA Gift Card!
SEND YOUR SUBMISSIONS TO: Amanda Hertig Corporate Marketing & Recruitment ahertig@unitedclaim.com
Thank you for reading!