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Out-of-Network Claim Management

Our aggressive discount negotiations save our clients in excess of 20% on visits to Providers outside of their proprietary networks. Our ownership and in-house management of our proprietary PPO network, North American Preferred (NAP), gives us the experience we need to negotiate effectively with Providers, achieving the deepest discounts for our clients.

Meritain understands that as a member it may be necessary to see a provider who is not participating in their network.  Meritain will review each of these claims.  Combining over 150 network relationships with an experienced team in provider recruitment and discount negotiation will save the member and client substantial costs.

100% of received out of network claims are automatically scanned for savings opportunities.  Meritain Health’s aggressive discount program saves clients 20% or more on visits to out of network providers.  The resulting impact to the client’s bottom line is a decrease of 2.5% in their overall health care expenditures.  Meritain Health - saving you money, saving you time.

Claims targeted for review and negotiation include, but are not limited to, the following:

• Large dollar submissions
• Excessive daily hospital charges
• Multiple surgical procedures
• Psychiatric services
• Durable Medical Equipment
• Home care
• Infusion therapy