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Epiphany Services Page-2

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

Examples of
Our Service Offerings

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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)

Retention 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

Services

Our Approach Is a Comprehensive Suite of Solutions

Tailored to address each client’s circumstances, interests and capabilities

Explore & Discover

Contracting Status

KPI Benchmarking

Technology Profile

Organization Profile

Identify & Prioritize (Examples)

Inappropriate Denials

Inappropriate Case Classifications

Inappropriate Down-coding

Inappropriate Contract Interpretations

Inappropriate Discounting

Notify & Pursue (Examples)

Claims Resubmissions

Arbitration

Class-action Law Suits

Single-Defendant Law Suits

Demand Letters

Settle & Collect

Legal Decisions

Legal Documents

Commercial Agreements

Receivables Collection

Enhance Operations Effectiveness

RCM Strategy and Development

Clinical and RCM Process Redesign

Customer Relationship Management Strategies

RCM Technology Modernization

Payor Contracts Redrafting

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