The Epiphany Group
The Epiphany Group (“TEG”) was created to assist healthcare providers (health systems, hospitals, and physician practices) in obtaining fair payment rates and transaction efficiencies from health plans. TEG believes that certain larger health plans have been systematically taking economic advantage of market conditions to the detriment of providers.
Our Services
The TEG “solution set” includes coordinated offerings to counter certain health plans’ systematic financial models and processes. Moreover, TEG believes an effective solution has both a prospective and retrospective component.
Retrospective
Solutions
include:
Implementing proprietary analytics to define scope of opportunity and best path to collection
Utilizing sophisticated termination clauses
Retaining of nationally-recognized lawyers to seek “Cease and Desist Orders” to stop current health plan illegal activities (e.g. utilization review and prior authorizations)
Retaining of nationally-recognized class action lawyers to seek corrective actions and damages for health plan misconduct and contract breaches
Prospective Solutions
include:
Reviewing existing contracts for rates, terms and “catch” phrases health plans use as weapons to down-code and deny payments of services to providers
Providing strategies for amendment and renegotiation of unfavorable contract provisions with health plans
Implementing denial management capabilities and systems to identify and counteract health plan denial practices
Providing management and technology-enabled controls to monitor health plan obligations to providers
Our TEG Team
Our service professionals are Senior Practitioners within their respective disciplines. These disciplines include:
Healthcare provider finance and operations
Revenue cycle management
Successful large project management
Healthcare law
Performance improvement
Healthcare litigation
Health plan operations
Healthcare contract review
Healthcare contract negotiations
Exploratory
Session
TEG would like to offer you a session to:
Introduce our team
Frame relevant industry background information
Present our coordinated, comprehensive approach
Provide recommendations to stop improper and illegal health plan practices and recover funds rightly due and owed to your organization
