Our solutions have consistently delivered measurable results, such as an average reduction of $11K per inpatient claim, a 1-2% improvement in the medical loss ratio, and the modernization of reimbursement methodologies, incentives, and relationships.
We have supported public and private healthcare providers and insurers in implementing FWA detection, value-based care frameworks, population health management, and various global projects aimed at optimizing cost and revenue management strategies to combat medical cost inflation.
About Payment Integrity Services
Payment Integrity Services
Get ahead of FWA trends, red flags, or leakage
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Our team utilizes cutting-edge analytics algorithms alongside clinical expertise to uncover and address unnecessary or erroneous payments in medical, dental, pharmacy, chiropractic, and DME services, as well as in DRG, CPT, and ICD-9/10 categories. Our work achieved millions in cost savings as well as clients' improved SIU structure and effectiveness.
Reduce and prevent billing and/or payment errors
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With over two decades of experience in forging innovative and strategic partnerships with diverse commercial and government payers, we excel at flexibly deploying specialized FWA talent for projects or staff augmentation, ensuring timely audit completion and empowering our clients with informed decision options and recovery ranges.
Upgrade payment integrity knowledge and SIU training
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We evaluate FWA program effectiveness for organizations of all sizes. Our comprehensive SIU services in the U.S. include arbitration, legal support, and expert testimony. Our customized FWA advisory and training elevate knowledge with strategic insights, helping organizations rethink internal processes and achieve their desired ROI.
About Medical Cost Management
Medical Cost Management Strategies
Increase cost containment program values
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We evaluate total medical costs and cost containment programs using a multidisciplinary approach that encompasses operations, unit costs, utilization, network configuration, and product incentives. Our efforts have uncovered millions in savings across global regions by addressing inefficiencies and misaligned behavioral incentives within these areas.
Accelerate insights and techniques to control cost
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Our expertise in crafting customized macro and micro trend analytics, combined with medical economics insights, has facilitated in-depth analyses and cross-correlations among business units, resulting in over $116M in savings across the US and global regions.
Broaden actionable insights from cost drivers and data
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We’ve delivered tailored workshops, prompting organizations in Dubai, the UK, the US, Singapore, China, Korea, and other regions to adopt actionable measures for enhancing affordability. Our workshops are conducted by subject-matter experts, and are designed to leapfrog knowledge with strategic and practical insights.
About VBC Transformation
Value-Based Care (VBC) Transformation
Transition from fee-for-serve to VBC framework
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With extensive expertise in bundled payments, DRG reimbursement, capitation, and ACO risk-sharing incentives, our team has a proven track record of collaborating with providers and insurers to develop win-win strategies and assess feasibility, thereby driving the adoption of value-based care (VBC).
Build win-win relationships with providers and payers
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We have established new strategic provider-insurance partnerships, expanding network by 30% across Europe, the Middle East, Africa, LATAM, and Asia. With expertise in global TPAs and major insurance collaborations, our team enhances services, networks, and customer experiences while driving operational efficiency.
Maximize desired impact from network effectiveness
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We have conducted in-depth analysis of network contracts, case mix, and utilization patterns to design and optimize tiered networks, Centers of Excellence (COEs), site-of-service networks, Accountable Care Organizations (ACOs), and other preferred provider networks, enhancing market competitiveness.
About Global Language Services
Supporting Services: Global Language Services
We provide comprehensive language and interpretation services specifically tailored to the needs of multicultural populations and global mobility projects. Our offerings encompass language training, translation, interpretation, and cultural competence in over 200 languages for any of our clients’ projects. We also offer support services to patients in a wide range of healthcare encounters, including consultations, intake meetings, rehabilitation sessions, discharge planning, and home visits, ensuring clear communication and cultural understanding at every step.
The SeidoHealth Difference
We advise through the lens of value discovery, delivery, and realization.
We understand the global healthcare landscape, including providers, payers, and consumers.
We leverage technology-enabled services solutions.
We use advanced analytics platforms and performance prediction tools.
We combine broad international knowledge with deep industry specialization.
We encourage innovation to disrupt what’s not working.