Strategies and measures aimed at controlling program expenses while maintaining and improving the quality of services provided.
Cost Containment Nurse Review
Hamilton & Archer Health Service’s stop-loss cost containment nurse experts are specialized Registered Nurses who work with insurance companies, insurance underwriters, Third-party Administrators (TPAs) and actuaries to help control healthcare costs, especially for high-cost claims. They focus on critically reviewing cases where health insurance claims may exceed specific deductibles or stop-loss limits. Our independent approach to assessing medical risk for stop-loss and fully insured products ensures risk and cost projections are based on current medical and cost trends. With over 50+ combined years of cost containment stop-loss nurse review experience, Hamilton & Archer Health Services is your trusted partner.
Hamilton & Archer Health Service’s stop-loss cost containment nurses can help your organization through:
Case Management: Our Registered Nurse Certified Case Managers (RN, CCM) review and oversee high-cost medical cases, ensuring that the treatment plan is appropriate, medically necessary, and cost-effective. Our RN, CCMs monitor cases closely to help avoid unnecessary expenses.
Coordination of Care: Nurse navigators collaborate with healthcare providers to streamline care, prevent duplicative services, and ensure all aspects of the patient's healthcare are coordinated effectively.
Claims Analysis and Reporting: Our stop-loss cost containment nurses have over 70 years combined experience in analyzing medical and claims data to identify cost thresholds. Hamilton & Archer Health Service’s nurses have a deep understanding of clinical care, insurance policies, and cost-control strategies, along with strong communication skills to interact effectively with underwriters, brokers and Third-Party Administrators (TPA).