Maritime Services

Equian helps health care payers and consumers maximize their health care dollars through innovative payment integrity solutions.

As a leading payment integrity company with experience in the domestic and international markets, Equian specializes in solutions for the Maritime industry to control medical costs. Our proprietary solutions provide payers and consumers with assurance that their medical costs are true, accurate, and reasonable.

The maritime industry faces challenges dealing with crewmember’s hospital and provider bills reflecting huge mark ups and the need for over site and review. Equian works closely with P&I Clubs, Vessel Owners, Cruise Lines, Vessel Agents, and Brokers and Port Agents to negotiate their crewmember’s medical bills – all while achieving the highest possible savings for the maritime payer.

Crew medical care, governed under Admiralty Law and the Jones Act, requires specialized processes that must be taken into consideration when designing the overall workflow and coordination, which is Equian’s area of expertise.

What We Offer

Bill Review

Clients requiring a broader spectrum of customized payment integrity solutions utilize Equian’s Bill Review services. Equian Bill Review services are customized solutions for our specialized markets and include the following service options:

Bill Audit
Bill Audit includes reviews for appropriateness, integrity and validity such as correct coding, medical necessity, usual and customary charge review, pre-existing condition analysis, coordination of benefits/third party liability and recovery, repatriation considerations, and coordinated review with client’s in-house medical review or contracted medical case review.

Medical Case Review
Equian employs contracted physicians and registered nurses to consult with clients regarding the effectiveness of a covered person’s treatment. Our network of board-certified physicians and registered nurses provides consultation and support related to implementing cutting edge cost containment and quality management strategies currently being used within the health care industry. Medical management services include prospective, concurrent and retrospective review, pre-certification, emergency room review, and utilization management reporting.

Negotiation
After a claim has been case reviewed and audited, Equian staff utilize all of the data to renegotiate the claim based on the audit and case review findings.

Case Management

Equian has been providing the very finest in managed care services for the Maritime industry for over a decade. We have established ourselves as a national leader in superior payment integrity and medical management services. Our ideas are innovative, our solutions are result oriented and our procedures are technologically superior. We never forget for a moment that the customer has a choice.

What Makes Us Different?

  • Customer Focused Company
  • Dedicated Regional Account Managers
  • Ability to Cater to Multiple Work-Flow Expectations
  • Dedicated Quality Assurance Professionals

Network Repricing

Repricing is the recalculation of billed medical charges based on the rates and rules a PPO has negotiated through its provider agreements. Equian manages the complexities of administration and data maintenance with over 100 connected networks and connected payors throughout the world. Equian partners with claims payors to relieve the administrative burden inherent with repricing management through the following services:

Primary Network Services:
Equian provides “single source access” to over 100 of the USA’s leading primary PPO networks. The primary network typically requires the client to utilize network logo identification on an ID card and/or steerage to providers through the use of benefit differentials. Providers associated with a plan’s primary network are typically considered “in-network.”

Secondary/Supplemental Specialty Network Services:
Equian provides secondary network access for out-of-network medical services. In addition, Equian provides a selection of supplemental or specialty networks designed to provide savings for specific services such as lab, dental, DME and more. Customers can maximize their savings by utilizing Equian’s network connections and sophisticated rules engine to design and administer a hierarchy of networks that will provide the largest impact on their claim flow.

Negotiation Services:
For charges that are not repriced through a network, Equian offers services to negotiate a discounted price on a payor’s behalf after the service has been rendered. Clients who are interested in Equian negotiation services may also be interested in our bill review / bill audit services. On average, payors access upwards of 20 different PPOs to serve the diverse health benefitt needs of its various group populations. This requires multiple connectivity solutions, claim feeds, formats, processes, and work-flows for each contracted network, which is complex and difficult for payors to manage internally.

Appointment Scheduling

Equian offers appointment services for cruise line and other maritime clients.  The primary function is obtaining the next available appointment within the requested specialty.  This service includes capabilities for specialty visits at port, and full coordination with the ship doctor, patient and provider of medical service.