The Difference is in Knowing
In 2018, Healthcare Horizons celebrates its 25th year in the healthcare industry. The company specializes in comprehensive healthcare claims audits, designed to identify and correct claims errors that can account for 1 to 3 percent of an employer’s overall healthcare spend.
“Many employers choose to self-insure their employees’ medical expenses to save money and maintain greater plan control by having a third-party administrator manage claims processing,” said Randy King, president. “However, one of the unintended consequences of self-insuring is that claims payers have no financial incentive to control costs, which may result in the overpayment or erroneous payment of employers’ claims.”
Healthcare Horizons, an affiliate of PYA, went from a concept scribbled on the back of a napkin in an airport restaurant to serving some of the largest self-insured employers in the U.S.
“Our clients trust us and know that we are committed to asking the right questions and protecting their financial interests,” King said. “We focus on all claims, but especially those that can really drain a client’s resources. Errors that may seem small to others can really add up when multiplied.”
Over the last 25 years, Healthcare Horizons has identified millions in recoveries for its clients, not including the potential money saved over time by correcting systemic errors. Recovered claims are returned to the client’s bottom line, allowing the HR department to directly contribute to a company’s bottom line performance and build the resilience needed to maintain benefits for employees for the long-term.
“I formed PYA not to be the biggest, but to be the best. Similarly, Healthcare Horizons is the best,” said Ed Pershing, founder of Healthcare Horizons and PYA. “We have far advanced the idea of 100% claims auditing resulting in better expense control, and our reputation for accuracy and independence of thought is unmatched.”
Today, the company, headquartered in Knoxville, Tenn., has built its reputation on its experience, expertise, excellent relationships with clients and third-party administrators, and commitment to uncompromising ethics and accuracy. When its leaders look toward the next 10 years, they consider annual healthcare claims audits as one way to exercise a measure of control over skyrocketing healthcare costs.
“Every carrier makes mistakes, and it’s really the only industry where this level of errors is accepted and understood as part of it,” Pershing said. “The magnitude of the healthcare cost dilemma is great, and high costs are on a growth path. Embracing the capability of claims auditing is one way to address the variables of healthcare costs.”
Visit Healthcare Horizons today to learn more, or contact us at hhadmin@healthcarehorizons.com to discuss a healthcare claims audit assessment.