Family of Companies A UNITED CLAIM SOLUTIONS COMPANY
Complete Care & Claims Solutions A UNITED CLAIM SOLUTIONS COMPANY A UNITED CLAIM SOLUTIONS COMPANY
CLIENT UPDATE
LOTS OF CHANGES New Leadership and “Agent of Growth”: Rob Gelb We are pleased to announce the addition of Rob Gelb, as Chief Revenue Officer, to the United Claim Solutions Family of Companies. Rob will be responsible for all Sales, Account Management and Marketing initiatives moving forward. Rob is located in Chicago, IL, and has traveled to all respective offices so he can learn about each service offering and how to best position them for transformational growth. He is an accomplished leader with a consistent record of strategic and tactical success in organizing, operating, managing and expanding profitable businesses. With his direct experience in healthcare, managed care, network development and mergers and acquisitions, we are excited to take this next step forward.
Easy Claim Submission via Cayzu
When you log in to UCX, our proprietary claims portal, you can now submit claims by simply uploading them via a secure form! Simply click the buttons on the UCX home page to request support or submit claims! It doesn’t get any easier than that! All claims are now being processed by UCS staff - the claim experts, and... our claim to fame! Make sure you are receiving the best possible savings on each and every claim by being proactive and getting ahead of those high dollar claims whenever possible. To gain access into the UCX Client Portal, contact: Shawna West, Account Executive Email: SWest@UnitedClaim.com Phone: (866) 762-4455 x109
On
90%
of the claims we touch, we save an average of...
51%
SUBMIT A CLAIM
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Stay ahead of the rumor mill!
Changes occur frequently at the UCS Family of Companies! Make sure to follow us on social media to stay informed!
THIS PAST YEAR... New President of Care Management, Amy Gasbarro In August 2018, the United Claim Solutions Family of Companies welcomed Amy Gasbarro as the new President of Care Management for INETICO, LLC. in Tampa, FL. As the former President of MCM Solutions for Betterhealth in Chicago,IL, Amy Gasbarro’s strong leadership and strategic vision has assisted INETICO in establishing a greater presence within the marketplace by enhancing its value proposition and synergizing its efforts in the payment integrity space through United Claim Solutions. Amy has over nineteen years of progressive leadership experience in the care management space serving TPAs, self-insured employer groups and Taft-Hartley Health and Welfare Funds, along with undergraduate and graduate degrees in Healthcare Administration. As a Board Member of SIIA, her vast knowledge and connections within the industry will help INETICO’s operational execution and financial performance.
INETICO Receives Triple-URAC Accreditation AGAIN! INETICO has achieved “the Gold Standard” for their Utilization Management, Case Management & Disease Management programs! INETICO President, Amy Gasbarro states “I am very fortunate to lead an organization that puts such a great emphasis on providing quality care management services to our members and clients. Our continuous pursuit of clinical excellence, evidenced by our triple URAC-Accreditation is the cornerstone of our value proposition.” Led by Janet Koch, Vice President of Clinical Care, she added “I am so proud of our team. They are the backbone of our programs and I am honored to lead such a talented group!”
Ask us about our... Development of new, strategic partnerships to continue bringing best-in-class Care Management solutions to our clients Integrated Pre-Service Negotiation Solutions Integration of the care component into NX Health Network solutions
CHANGE BRINGS Zebu Compliance Solutions added to the UCS Family of Companies Zebu is a software enabled business, providing payment integrity and ongoing credentialing solutions to payors, clearinghouses, and provider organizations across the United States. Our acquisition of Zebu brings additional resources and capabilities to UCS, augmenting its suite of payment integrity solutions and expanding its customer base. UCS and Zebu have had a strong working relationship over the past seven years. Formalizing our partnership with Zebu enhances our service offering and technology capabilities, enabling us to better serve our clients’ needs. Zebu brings us an experienced and talented team, led by industry veteran Francesca Hartop, Zebu’s Founder and CEO. Francesca has deep industry knowledge that has helped establish a comprehensive suite of tools across both payor and provider markets. The Zebu-UCS platform will facilitate high-value integrated & complementary services to better serve our existing customers and further extend our product offerings into new customer segments. Our goal is to create efficiency and integrity across the health care landscape. Zebu’s partnership with UCS creates a comprehensive suite of health care claims management and compliance solution.
Full verification of correct coding and coverage for public and private payers. Supports preservice, post-service & audit implementations.
Monitor staff and vendors for exclusion, licensing and disciplinary status with Medicare, Medicaid OIG, State, NPDB & regulatory boards.
Get claims coded and paid right the first time with a full suite of integrated coding, coverage and reimbursement tools.
Triage medical necessity for Medicare and private payers prior to service delivery.
Integrate the most reliable data in the industry. Full service content supported by nationally certified coding and compliance experts.
OPPORTUNITY!!! A High Value PPO Unlike typical PPOs, where any willing provider is invited to join the network, NX Health creates narrow networks in cities across the country that direct patients to choose from a select, customized list of providers that are fully credentialed. The promise of a real increase in new patients prompts these physicians and hospitals to contract at substantially lower fees. NX Health’s narrow, high value networks deliver: Value for Network Providers Value for Employers Value for Employees and Their Families NX Health continues to have productive conversations work with brokers and TPAs across the country to target new networks. As an organization, we expect to add 4-6 new networks in 2019!
18%
Clients continue to experience claim savings! These savings are OVER our clients’ prior network performance!
Three new networks: Fresno, CA Las Vegas, NV Longview, TX Under development: Omaha, NE Reno, NV
Jennifer Alvarez ACCOUNT MANAGER Start Date:
November 27, 2017
Three Strengths: • Determined • Dedicated • Team Player
Three Weaknesses:
• Patience • Being too critical of myself • Latest Information Technology
Best Part of Working at the UCS Family of Companies:
Everyone is such a team player and always willing to offer a helping hand - even for the smallest thing. Coming into a family of companies where everyone makes you feel so warm and welcome is probably what makes adjusting to a new job that much easier. The constant growth opportunities are beyond amazing and makes me strive to learn more each day.
Who is your role model & why?
My grandfather was my role model. He was an extremely humble, smart, and loving person. Everyone that knew him, loved him! He helped me grow into the independent woman that I am today.
Hobbies:
My Cute Grandparents
• Going to the beach • Shopping • Spending time with my family • Theme Parks
e sisters!)
Close friend & I (lik
What is your greatest accomplishment? Always growing and pushing myself to do better.
What major goal(s) do you hope to accomplish someday? Becoming a mother!
Favorite food & beverage: Pasta and COFFEE Favorite TV show / movie: This is Us / Bad Boys Household chore you LIKE to do: Cleaning (lol) Things people do not know about you that you wish they did: I wear my heart on my sleeve
My siste
Your family includes:
1 brother, 1 sister, 1 step-brother, 1 step-sister and an AMAZING mother!
If there were an extra hour in the day, what would you do with it? Probably spend it outdoors
What cartoon character do you think you relate to most & why? Winnie the Pooh because he loves to eat and he’s funny
My mom, brother, his wife & me!
r&I
Predictions
Employers Will Be Key to Transforming Healthcare This past year was a year of seismic shifts that saw large companies coming to the table to find their place in a changing American health care system. The trend might be summed up as such: the private sector is taking health care by the reins. And, at an increasing pace, we saw U.S. employers explore different methods of providing quality care for their employees, without breaking the bank. As we’ve watched employers continue to rise to the occasion, it has become increasingly clear that these stakeholders are the gatekeepers to transforming the health care system—making this far more than a passing trend. As this momentum continues, 2019 will surely be an interesting year of change for employers, employees, and the health care industry as a whole.
Getting in front of high-cost claims
Self-funding for health care benefits comes with its risks and benefits. The benefits include program control, flexibility in plan design, and more predictability in costs. The risks are in the high cost claims, specifically from cancers and musculoskeletal conditions. Costs related to musculoskeletal disorders skyrocketed by 131 percent from 1996 to 2014, and total spending on cancer treatment is expected to increase 27-36 percent in the next decade. In order to address these trends, employers must get ahead of the curve before the conditions escalate. The tools available to keep cancer and MSDs at bay are prevention, detection, and on-going support from cost-containment vendors, such as the United Claim Solutions Family of Companies. Unfortunately, we still have a ways to go until medical cures are identified for these conditions, but until then, identifying risk factors early on, encouraging employees to make lifestyle changes, and offering individual, peer and group programs will be the best way for employers to enable the longevity of their workforce without breaking the bank.
Keeping mental health in mind
Considering mental and behavioral health care will become central to many employers’ benefits strategies in the New Year, and with good reason—each year, more than 70 million working days are lost due to mental health, costing employers more than $276 billion. As mental health conditions like anxiety, depression, and chronic stress become more and more prevalent, increasing access to mental health services will only be the starting point. Employers who truly want to improve their employees’ health outcomes and boost productivity will make mental health a core part of their culture, addressing the stigma of mental health conditions, and begin offering onsite mental health counseling for those who need it.
Onsite health care: A benefits staple, not a perk
In 2018, many large employers announced new onsite health clinics and made waves with this approach to fixing a broken health care system. This movement helps employers have healthier, more productive employees while addressing the ever-rising cost of care. Onsite (worksite) health centers have been operating for more than a decade at employer organizations committed to delivering a better, more effective patient experience, supported by technology and longer appointment times to address patient needs. Employers are constantly finding new ways to remain committed to improving health and lowering the cost of care for their employees. Adapted from an article by Marlene Satter, BenefitsPro Magazine, December 14, 2018
FIVE QUANTIFIABLE PREDICTIONS & HEALTH TRENDS FOR 2019 (Last year’s predictions were 98% accurate*) 15% of global healthcare spending will be tied to value-based models and outcome-based care concepts
Artificial Intelligence (AI) for healthcare IT will cross $1.7 billion, which will result in a 10% - 15% increase in productivity Digital health tech catering to ambulatory surgical centers (ASCs) will grow by 30% 50% of all healthcare companies will have resources dedicated to analytics for use across their organizations Innovative private insurance models shake up healthcare payer industry (5% - 10% linked to lifestyle data)
*Adapted from an article by Reenita Das, Forbes Magazine, November 13, 2018
WORK ANNIVERSARIES January 2: January 2: January 11: January 11: January 12: January 25: January 29: January 30: January 31:
Ryan O’Mahoney, Vice President of Operations (6 years) Jaxon Current, Software Developer, Team Lead (5 years) Art Hoath, Executive VP of Sales (3 years) Ronnie Brown, Vice President of Client Services (3 years) Peggy Steiner, Account Manager (4 years) Lisa Perkins, Care Operations Manager (9 years) Samantha Fyffe, Credentialing Services Supervisor (1 year) Maria Gonzalez, CM Nurse (2 years) Kate Howell, Claims Manager (13 years)
Your Opinion is Paramount With all of the changes occurring within the United Claim Solutions Family of Companies, and the healthcare industry as a whole, we would like to take a few minutes and focus on what truly matters how we performed for our partners and clients in 2018. Our goal is to provide the best service, savings and solutions in the industry. If there is something we are doing well, or things we can improve on, we appreciate any input and feedback you are willing to provide. We kept this short on purpose and should you choose to participate, it should take just a few minutes to complete.
Each survey filled out will be entered into a drawing to win one of two $100 VISA Gift Cards! Please complete the survey by clicking the button below by January 28th!
United Claim Solutions, LLC 23048 N 15th Ave Phoenix, AZ 85027 (866) 762-4455 www.UnitedClaimSolutions.com