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OUR CORE SERVICES INCLUDE

International & US medical cost containment, claims negotiation and medical assistance services

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Quality of work and industry experience

Penfield’s team members are our most valuable asset. They are what sets Penfield so far ahead of other service providers in the industry.

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Lowest medical costs

Our suite of services and products drive strong savings for any diagnosis at any facility in the US.

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Relationships


Our extensive network and long working relationships with many providers help us work with any US-based clinician.

What sets Penfield apart from other cost containment organisations is our:

Laser focus on ensuring client satisfaction

Making our customers feel special, and not just a number

Every client works closely with their own Penfield dedicated account team

And we go that extra mile, which is why our NPS (Net Promoter Score) is so high

Services

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Claims Negotiation

Penfield’s negotiators use evidence-based criteria to ensure a reasonable reimbursement to the healthcare provider. An assessment is performed on both the claims and the provider and benchmarked against industry data. Each successful negotiation comes with a signed agreement with the provider to protect clients from any appeals.

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Provider Network

Penfield leverages access to a vast healthcare provider network of physicians, hospitals, clinics, surgery centers, and pharmacy benefit managers to bring the best net savings to clients. The network is comprised of regional and national PPOs, HMOs, and direct contractual relationships.

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Medical Bill Review

The medical bill review program takes a hands-on approach to forensically analyzing medical billing to identify billing errors and unbundled charges. Algorithms can provide efficiency, but they are no substitute for a professional coder performing a line-by-line review. Line-item reviews find what algorithms overlook. Penfield nurses review each episode of care for clinical correctness, medical necessity, and appropriateness of treatment. Findings are used to reduce the payable to the healthcare provider and, where possible, a negotiated settlement is secured. A negotiated solution delivers the best value and peace of mind through closure.

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Directional Care

One of Penfield’s unique cost containment strategies includes the ability to direct members to appropriate healthcare providers who rank high in quality in a given specialty and geographical region. Directional software also assists in determining the best cost outcome amongst available providers, so that members receive the best level of care at a reasonable cost.

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Case Management

Ensuring the most effective delivery of care and monitoring provider utilization is a significant component of any medical cost containment strategy. Staff nurses, in close coordination with our clinical director, use industry care guidelines to ensure that the most effective delivery of care is achieved. Our team’s number one objective is securing the best the care for the member, while monitoring for opportunities to get them back home for continued care in their country of origin.

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Reference Based

From full replacement to any of the RBP variations, Penfield has the data and processes to reprice claims smoothly and take the sting out of balance billings. By blending cost and quality data into negotiated settlements before members receive care, Penfield’s RBP programs provide a softer, more manageable approach that delivers impeccable service and unbeatable value.

Recent News

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How does health spending in the U.S. compare to other countries? - Peterson - KFF Health System Tracker

In 2022, the Unite States will stand out as the global leader in health spending, with a staggering $11,072 per capita. However, this does not necessarily equate to Lorem ipsum dolor sit amet consectetur adipisicing elit. Ab sunt cumque itaque tempora blanditiis similique, maiores non alias ipsa mollitia.

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Combating Alzheimer’s With Focused Ultrasound Drug Delivery

The use of focused ultrasound technology for drug delivery in Alzheimer’s treatment has shown promising results. By targeting specific area of the brain, this approach may enhance the effectiveness of medication…

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Forbes.com

4 min read

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𝗣𝗲𝗻𝗳𝗶𝗲𝗹𝗱: 𝗔𝗰𝗵𝗶𝗲𝘃𝗶𝗻𝗴 𝗮 𝟳𝟭% 𝗗𝗶𝘀𝗰𝗼𝘂𝗻𝘁 𝗼𝗻 𝗠𝗲𝘁𝗮𝗯𝗼𝗹𝗶𝘀𝗺 𝗗𝗶𝘀𝗼𝗿𝗱𝗲𝗿 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗖𝗼𝘀𝘁𝘀

In a complex medical case at a New York hospital, a 52-year-old male was admitted for a day due to a metabolic disorder. The extensive treatment led to an initial bill of $𝟯𝟳,𝟱𝟵𝟱.𝟲𝟬. Recognising the need for a fair and equitable settlement, Penfield meticulously evaluated the medical claim against the Medicare fee schedule…

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Linkedin.com

2 min read

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Managing catastrophic medical claims

From catastrophic claims to customer service, the experts at Penfield have shared their insights on the key points of managing catastrophic claims. With the right expertise and resources, companies can stay ahead of the curve by understanding the changing landscape of the industry.

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itij.com

1 min read

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What to Watch in 2024: The Latest Health Cost and Affordability Issues and Trends | KFF

In the coming years, the healthcare industry in the US will continue to grapple with the challenges of cost and affordability. This was highlighted in a report by the Kaiser Family Foundation, …

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kff.org

2 min read

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Penfield Achieved Significant Savings for Hospitals and Clinical Costs

When it comes to spine surgery, you need to be sure you're getting the best care possible. We are proud to say that we were able to achieve for our client an 𝟴𝟬% 𝗱𝗶𝘀𝗰𝗼𝘂𝗻𝘁, which saved them a whopping $𝟮𝟴𝟴,𝟰𝟬.𝟲𝟭! …

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Linkedin.com

3 min read

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Low-glucose sensor in the brain promotes blood glucose balance

Does the brain play a role in blood glucose regulation? Researchers at Baylor College of Medicine found evidence in animal models that glucose-sensing neurons in the brain are important for whole body glucose regulation, including during…

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ScienceDaily

5 min read

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