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Health Payment Systems (HPS) of Milwaukee, WI, and Trilogy Health Networks (THN) of Brookfield, WI, have announced the formation of a strategic business alliance to provide employer-sponsored self-insured health plans with a comprehensive network of providers at deeply discounted rates. Cypress is proud to be one of the select few administrators able to offer this arrangement. Learn more.
ARGUS Advantage Series: ARGUS Claim Review - a division of Cypress Benefit Administrators - guards against costly healthcare billing errors, issues with medical claims processing and other claim system deficiencies. Learn more about how this industry-leading system works via this series of occasional articles.
Understanding Medical Necessity Review Procedure
Cypress's responsibility as an administrator of claims is to be sure medical providers are compensated for the services they perform for our client's employees and family members. It is also our duty to be sure the services being billed are payable under our client's Summary Plan Description (SPD) and are medically necessary -- which is why all claims submitted by any provider are subject to review. Health Care Anti-Fraud Association estimates that $68 billion is lost annually to fraud and abuse. Learn more about how 'medical necessity' is determined and how ARGUS Reviews help control health care costs.