Penfield prides itself on its reputation as the ‘Best In Class’ organization for medical cost containment, claims negotiations and medical assistance. Our company is built on the three key principles of quality, transparency and providing unrivaled client satisfaction.
Penfield’s team members are our most valuable asset. They are what sets Penfield so far ahead of other service providers in the industry.
Our suite of services and products drive strong savings for any diagnosis at any facility in the US.
Our extensive network and long working relationships with many providers help us work with any US-based clinician.
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
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.
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.
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.
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.
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.
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.
Penfield’s Medical Assistance team is comprised of nurse case managers, assistance coordinators, and physicians with experience in emergency travel care. The Company uses an evidence-based care management approach to ensure health care providers are following proper care guidelines through remote Utilization Review.
The Penfield Assistance team can also provide a customized solution for assistance needs such as flight and accommodation coordination, the scheduling of appointments, or return of vehicles.
Penfield offers efficient and cost-effective air ambulance solutions through a carefully curated network of air ambulance providers. The process of selecting an air ambulance provider for a transfer needs to account for many variables, but the priority is always what is best for the patient’s medical outcome.
Penfield provides claims administration services to handle all client needs. Penfield’s bespoke system allows clients to closely monitor and engage in the claims process, and provides a full suite of claims management functions through a highly efficient process with industry-beating reporting capabilities.
All claims are reviewed by staff specialists for recovery opportunities. Whether a matter involves recovery of no-fault benefits, asserting ‘priority on risk’ or other ‘coordination of benefits’ type claims with another insurer, or other third party liability scenarios, the Penfield network of dedicated specialists delivers economic results for clients in any lawful jurisdiction worldwide.
Establishing a relationship with members and their families is essential to maintaining a smooth flow of communication. Ensuring the proper delivery of care and looking out for the best interests of the patient and family takes precedence and ultimately contributes to a positive outcome, both clinically and financially.
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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