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Obtaining fair payment rates and transaction efficiencies from health plans for healthcare providers.

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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.

Services
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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

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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:

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Healthcare provider finance and operations

Revenue cycle management

Successful large project management

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Healthcare law

Performance improvement

Healthcare litigation

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Health plan operations

Healthcare contract review

Healthcare contract negotiations

Our senior level executives have substantial experience on both the provider and health plan side of the table, enabling TEG to bring a 360-degree perspective to revenue cycle management and litigation.

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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  

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