Health Plans / Payors
We help to ensure that health plans pay only for valid, correctly billed claims, freeing up funds for critical programs. Our ClaimsWise™ service combines meticulous code edit on every claim and expert record review where appropriate, maximizing savings and efficiency.
Key benefits include:
Customized Solutions: Tailored to each client's unique business profile, incorporating CMS, state legislation and plan-specific contracts and policies.
High Realization Rate: 99.53% on identified savings, with average savings of 4% to 13% of claims value analyzed.
Efficient Implementation: Typically 8-12 weeks with no upfront costs, and immediate savings from day one.
Minimal Disruption: Seamless integration with existing teams and systems, as well as full support for provider queries, ensuring minimal administrative burden.
Our contingency-based pricing means we only get paid on a percentage of the realized savings, ensuring our incentives are perfectly aligned with yours.
Nokomis finds what
other vendors don’t
We go beyond surface-level analysis to identify errors, upcoding and unbundling of claims from healthcare providers. Our comprehensive approach allows us to uncover savings that no one else can.
On average we save 15.8% on E&M claims across our clients.
Saved on E&M claims where we requested and reviewed medical records.
Nokomis Health partners with third party administrators (TPAs) to enhance the efficiency and accuracy of claims processing for self-funded payors.
Our ClaimsWise™ service meticulously reviews each claim through comprehensive code edits and expert record reviews, ensuring only valid, correctly billed claims are paid.
This rigorous approach helps TPAs reduce errors and overpayments, ultimately leading to significant cost savings and improved client satisfaction for the self-funded payors they serve.
We ensure our services integrate seamlessly with existing systems and processes. This tailored approach allows TPAs to maintain smooth operations while benefiting from our expertise in claims accuracy and payment integrity.
Implementation with Nokomis Health is efficient and straightforward, typically completed within eight to twelve weeks without any upfront costs.
From day one, TPAs start to see immediate savings as we identify and rectify incorrect claims in real-time.
By partnering with Nokomis Health, TPAs can trust they are maximizing financial efficiency, reducing errors, and delivering enhanced value to their self-funded payor clients.
Members
Our ultimate goal is to improve the overall healthcare experience for members by ensuring their health plans operate efficiently and effectively.
By partnering with health plans and stakeholders in the ecosystem, we help ensure that only valid, correctly billed claims are paid. This meticulous process not only prevents financial waste but also allows health plans to allocate more resources towards enhancing the quality of care and services for their members.
Our commitment to accuracy and integrity in claims processing means that funds can be redirected towards health equity programs, community projects, and other initiatives that directly benefit members.
By reducing the administrative burdens and costs associated with incorrect claims, health plans can focus on improving access to care, reducing premiums, and enhancing member services.
We believe that by supporting health plans in their mission, we are indirectly but significantly contributing to a better, more equitable healthcare system for all members.
Nokomis ClaimWise™
Nokomis’ ClaimWise application was built 11 years ago to codify and automate the combined knowledge of our teams’ vast coding and billing experience. We are constantly evolving and developing ClaimsWise™ to stay ahead of a rapidly changing industry.
Nokomis Health is dedicated to fostering a transparent and efficient healthcare ecosystem, benefiting both providers and unions. For providers, our ClaimsWise™ service ensures fair and accurate claims processing, reducing the incidence of denied or delayed payments. This helps maintain the financial stability of healthcare providers, enabling them to focus on delivering high-quality care to their patients.
Additionally, we offer educational resources and direct assistance to providers, helping them understand and rectify billing issues. This collaborative approach minimizes billing errors and strengthens the relationship between providers and health plans, contributing to a smoother, more efficient process for providers and better patient care.
Labor Unions benefit from our efforts to ensure efficient use of health plan funds, minimizing waste and maximizing resources for member care.
Our diligent claims review process helps achieve significant cost savings, which can be redirected towards improving member benefits and reducing out-of-pocket expenses. This enhances the value of the health plans and aligns with unions' commitment to securing the best possible healthcare for their members. By ensuring the financial health of the plans, we enable unions to negotiate better terms and provide greater security for their members' healthcare needs.
Nokomis Health is proud to support all members of the US healthcare ecosystem in their advocacy for fair, affordable, and high-quality healthcare for all.
Want to learn more? Let's talk..
Find answers to common questions about Nokomis' services, how they work, and the kind of results US Health Plans can expect.
