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How do you know if an individual’s cancer treatment includes experimental or investigational drugs? What is the standard of care for a premature baby or a complicated newborn? How do you determine if services are medically necessary and reasonably priced? Can hospital charges be reduced even if there is a PPO discount? How do you decide which transplant network to use?

MedNet Munich Health North AmericaSM (MedNet) was developed to answer these and other difficult claim questions.

MedNet brings together best-in-class service providers that have demonstrated their ability to achieve the best possible clinical and financial outcomes. Innovation, experience, advanced specialty training and clinical and business intelligence are the reasons that MedNet service providers can deliver these outcomes for your members while protecting your bottom line.

Their expertise includes:

  • Medical case management: Focuses on having the right kind of care in place to manage a complicated illness or injury.
  • Organ transplant networks: Provides fee arrangements for organ transplants and assists in the management of transplant-related illnesses.
  • Care of premature babies and complex newborns: Uses a multi-disciplinary team of experts to resolve key issues and offer evidence-based solutions.
  • Bill review and audit: In-network and out-of-network claims review by highly skilled medical professionals who identify errors, negotiate fair reimbursement and obtain signoff from providers.
  • Renal dialysis claims management: Provides case specific cost containment settlement options.
  • Oncology claims management: Helps manage patient care and the costs associated with cancer treatment.
  • Physician consultants: Helps determine medical necessity, experimental/investigational, length of stay and quality of care issues.
  • Pharmacy benefits managers: Specializes in complex and chronic conditions that require specialty, bio-tech or infusion medications.
  • Subrogation and overpayment recovery: Uses leading edge technology and legal expertise to uncover missing recovery opportunities.
  • Claims tools: DRG validation, claims editing and pricing data.

Easy access to an integrated process

The process starts with access to Munich Health North America claims experts and Medical Risk Specialists. They take a coordinated approach to managing care and controlling costs.

Our team will help you select the right combination of service providers to assure the best possible outcomes.

The end result

Whether it’s a complicated cancer case, premature baby or a high dollar hospital bill, MedNet will help you manage the care and associated claim costs.

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This publication is available exclusively to Munich Re clients. Please contact your Client Manager.