Counseling, audit, and medical management

The management of health benefits and medical counseling involves legal risk to the company due to the possibilities of negative authorizations for procedures and homecare, and changes in plans. As a Third Party Administrator, we can provide valuable second opinions based on our experiences with a large portfolio of clients, and our specialized legal and technical expertise.

Healthcare in Brazil still involves a great deal of inefficiency with regard to the revenue cycle and the generation of medical bills starting from the initial provider.

To better understand the company health insurance, we conduct technical analyses that take into consideration the identification of healthcare indicators, and the prices of products and procedures compared to the market.

We believe that health benefit claims should be carefully examined for identification of inconsistencies and unauthorized charges. In our experience, 30% of the total claims represent expenses that should be investigated and/or contested with the health carrier.

In many situations, we recommend medical audit with monitoring of cases starting with the initial provider to verify the quality of the service provided and the medical bills.