OneSolutionFor Medicare Reference Pricing Programs

Technology + Patient Advocacy + Legal Strategy = SavingsA successful reference-pricing program requiresa comprehensive approach. ResourceOne has assembled a team of experts to help manage your reference-pricing program from plan inception to claim resolution. This includes consulting on plan design, member education, patient advocacy,medical management, comprehensive reference pricing, appeal management, provision of member and provider liaisons, and balance-bill negotiation.

Technology - Automation and Claim Pricing• The OneSolution system manages claims coming and going• ResourceOne supports Medicare or Medicaid as a basis for accurate

reference pricing and employs unique technologies to fill gaps• It also provides far more automation and much greater accuracy than

other solutions on the market

Patient Advocacy - Plan Design and Member Engagement• Experienced consultants review your plan documents, ID-cards, and

EOB design to harmonize all program components and establish a sound legal strategy

• Patient advocates engage in member education about your plan• Provider liaisons contact members’ current and prospective providers

to establish acceptance of plan terms and create a list of safe-harbor providers

• Clinical experts conduct pre-admission screening for medical necessity, which includes physician review

• These experts continue with pre-certification screenings according to your plan’s terms, case management, disease management, utilization management, and discharge planning and referrals

Legal Strategy - Appeal and Balance-Bill Management

• Reimbursement, plan, and clinical experts respond to appeals and balance bills

• They use response letters drafted by experts with many years’ experience

• OneSolution provides escalation procedures using established legal strategies

• And we refer you to a network of lawyers across the country for intractable cases

CompleteOneSolution is much more than bill settlement and negotiation. It’s a complete service that starts before members see providers and continues through every step of care and billing.

KnowledgeableBy putting together domainexperts for each phase of reference-pricing programs, ResourceOne has the right tools and strategies in place to maximize success and savings.

Thorough

ResourceOne employs stateof-the-art technologyto move, manage, and priceclaims precisely according to plan guidelines. Broad,comprehensive patientadvocacy ensures thatpatients get the best carewith the least possible hassle. And proven strategy based on established legalprecedent greatly reducesbalance-billing concerns.