The most critical factor for the success of a medical assistance provider today, besides having an excellent Network Access and Quality Service, is its strategy concerning Cost Containment.


The objective of containing or controlling costs is not to reduce Medical Assistance without regard to benefits; rather, the objective is to achieve the appropriate balance between the costs incurred and the benefits received.

Some of the Keys to Successful Medical Assistance Cost Containment

Process Description
Network Management Broad range of Medical Assistance Services and Providers
Network Manager
Network Performance Analysis
Harmonization of Administrative Procedures
Volume, economies of scale
Case Management Individual Claim Review
Insured tracking
Customized File Exchange
Unbundling of charges
Utilization review
Comparison of charges vs. documentation
Large Claims Review and Audit Careful Follow-up
Key coordination
Benchmarking Price conditions
Service Levels
Subrogation and Recoveries Recoveries
Third Party Liability
Claims Abuse and Fraud Measures Claims Abuse and Fraud Measures

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