As a preferred business partner to leading healthcare organizations, we understand the cost of healthcare must be managed diligently and effectively. We take the lead on program management so our clients can focus their attention on their own market leadership. We also offer flexible program management options so clients can complement their own capabilities with only the services they need from us. Whether they select a comprehensive benefit management solution, specific Vestica Healthcare services, or a changing mix over time, we ensure our clients’ programs are actively managed for success.
Vestica Healthcare offers a team of specially trained case managers ready to assist with managing the health of members of our clients’ programs. Our team operates based on client-defined business rules and can also recommend leading practices in order to better track, plan, manage and authorize services for your membership. When utilized with our leading-edge claim processing, case management services provide an integrated level of care for your members and help you control your overall benefit cost.
Fraud, Waste & Abuse Detection
With a highly experienced team and sophisticated technology, Vestica Healthcare works to expose potential fraudulent services and abusive billing practices, often before services happen. The Enterprise System, our proprietary software platform, is designed to detect unwarranted claims for service and fraudulent billing. We’ve also built fraud prevention into our workflow processes. By bringing this critical information to the attention of our clients, Vestica Healthcare helps reduce cost and ensures benefit resources are not diverted from populations which need them most.
We are regarded by industry experts as the “safe choice” when it comes to compliance with new regulatory and client business requirements. Our track record shows we have consistently completed new regulatory requirements well in advance of their effective dates, including compliance with HIPAA 5010 transaction sets and ICD-10 coding.
In 2013, Vestica Healthcare and our sister company Scion Dental became the first two companies to achieve URAC full accreditation for Claims Processing Administration with Claims Review and Appeals, Version 4.0.
Grievances & Appeals
Vestica Healthcare’s experienced team responds to every instance of a complaint, grievance or appeal fully and completely, as quickly as possible. With the Enterprise System, our team logs, tracks and monitors all complaint and appeal activity in real-time, ensuring a quicker and more thorough resolution. By providing our clients the same access to real-time monitoring of grievances and appeals, we deliver greater transparency into their medical benefit program.
Vestica Healthcare works closely with clients to develop member outreach programs designed to meet specific goals for member participation.