Welcome to IBA

Medical Cost Containment Solutions

We offer service-oriented medical management and cost containment services that aid our clients in controlling their medical costs and maximizing savings, while ensuring that our members receive quick and valuable information whenever they need it. The programs work directly with our members to provide the support the need to make the right health decisions.

Medical Bill Review

Mishaps such as data entry error, wrongly priced or charged claims, and inadequately bundled services can cause financial burden to any plan sponsor. Our medical bill review service uncovers any billing errors that may take place. A team of highly skilled audit nurses engage in a three-tier approach (clinical, financial, and client-specific) to determine the appropriateness of each billing. All adjustments are secured by a provider signature, thus eliminating the need for appeals. This ensures a quick and accurate process every single time.

Out of Network Claims Repricing & Negotiation

Through PHX’s Out-of-Network relationships, IBA is able to provide deep discounts through claims negotiation and claims repricing. Because PHX has such expertise in this field, they are able to negotiate a 30-50% savings for 90% of the claims they handle. For IBA clients, this means that approximately 9 out of 10 Out-of-Network claims will get a significant discount, greatly lowering the cost of healthcare.

Clients also get direct access to the PHX Choice Network, which provides significantly reduced rates for thousands of medical providers that do not associate with most PPO’s. This allows for even more savings and discounts for our clients.

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Our standard programs include:

Utilization Management

This URAC-accredited program is designed to positively impact claims costs and provide large savings to benefit plans, which will help avoid preventable high-cost procedures and hospitalizations. A highly-specialized team of board certified practicing physicians and experienced registered nurses:

  • Certify treatments
  • Direct members toward the most cost effective, quality treatment available
  • Perform concurrent and retrospective reviews

*Reviews are supported by American Health’s state-of-the-art proprietary software that facilitates all the steps in the utilization review process and automatically identifies cases appropriate for Case Management intervention.

Case Management

This URAC-accredited program is focused on directly working with our members to improve their quality of care, while also appropriately maximizing cost savings. We provide members and their families a better understanding of specialized care needs, access to the top medical centers and specialty care facilities, and education on beneficial alternatives to costly inpatient care. We also guide the members to utilize our in-network providers so that the claims will be eligible for the in-network PPO discount.

Our Case Managers are licensed registered nurses and social workers who function as advocates, facilitators, and educators. They work directly with the members and their families, as well as health care providers and facilities to create a treatment plan that ensures the most cost-effective way to provide the best treatment available.