CMN’s Preferred Provider Network consists of over 7,000 acute care facilities and over 400,000 physicians and specialists in over 200 countries. In order to ensure CMN works consistently with the best providers at the best price, we regularly review and evaluate our contractual relationships with all our providers.

CMN’s network covers all medical specialties including, but not limited to, specialized diagnostics testing, neo-natal care, cardiac care, serious trauma injuries or burns, oncology, orthopedic, general to specialized surgery, and organ transplants.

CMN’s dedicated, multilingual case management and customer service teams can be reached from anywhere in the world, 24/7, 365-days-a-year, to provide help to individuals requiring emergency medical assistance, air ambulance evacuation, or travel assistance.

CMN’s Full Third Party Administration (TPA) offering provides our clients with “one-stop shopping” when it comes to managing the medical care and assistance services of their insured members, whether locally or overseas.

Our TPA services include:

Claims adjudication and payment (multi-currency)

24/7, 365-days-a-year access to:

A multilingual customer service team

Emergency assistance services

Medical case management

Claims receipt (EDI, U.S. and Overseas post office box forwarding)

Our web portal interface

Network access

Full back office support and service

How We Improve Your Service

The following chart illustrates how CMN's Claims Management team has significantly improved the claims turn around time for one of our clients after taking over the business in March, 2009.

CMN’s highly trained and experienced case managers, nurse case managers and medical directors work as a team to manage all aspects of a patient’s case; from initial contact to the individual’s safe arrival back home. Our medical case management team’s goal is to provide empathetic patient advocacy while effectively monitoring our clients’ costs.

Services conducted by our case management team include:

• Actively directing patients to more cost effective facilities
• Pre-authorizations/pre-certifications
• Coordination of hospital admissions and medical appointments
• Ongoing monitoring of patient treatment plans
• Regular communication with patients and their families
• Coordination of referrals
• Discharge planning
• Air ambulance and commercial evacuation coordination
• Arrangement of follow-up home appointments to ensure the patient’s physicians are informed of the treatment received overseas and of his or her current medical condition.

Our medical claims experience covers all facets of the claims process and is backed by a state-of-the-art web-based system that allows for customized support and tracking of each client's specific processes and needs. Our detailed reporting and consultative analysis further enhances these partnerships.

Our claims management services include:

• Inpatient claims review—identifies inpatient claims with potential upcoding, diagnosis sequencing errors, place of service issues, and diagnosis-related group (DRG) creep through the use of a customized audit process.
• Outpatient claims review—identifies hospital outpatient coding errors, unbundling, case rate violations, as well as documentation, and contractual issues through the use of Medicare’s Outpatient Code Editor and reviews.
• Professional claims review—identifies improper CPT-4 coding to eliminate inappropriate or increased payment of professional claims through the use of nationwide-accepted professional coding references.
• Claims processing and adjudication— in accordance with the insurance policy terms and conditions.
• Claims repricing – utilizing CMN’s preferred provider network or other best-in-class preferred provider networks when a direct contract is not available.

CMN’s history of bringing international patients to the U.S. and providing these individuals with access to top-quality healthcare facilities has resulted in CMN being able to establish direct relationships with many of the U.S.’s leading center’s of excellence.

Our Centers of Excellence Program allows our clients to combine quality care with cost-effective rates. Centers of Excellence are selected through our in-depth reviews, third party assessments, and client recommendations. Our patients are automatically recognized upon admission into one of these centres and, as such, costs are reduced significantly and V.I.P. treatment is received.

CMN’s large claim review and audit services provide clients with a full claims audit that includes line-by-line reviews of billed charges to identify and exclude any technical and coding accuracy errors. This results in claims charges being reduced before the application of the discount or reimbursement.

Our medical staff and coding & billing specialists have extensive experience and knowledge in provider billing practices, and conduct a thorough review of all line item charges submitted by the providers. Our specialists will then, on behalf of the payer, apply reimbursement methodologies promulgated by the UB-92/ UB-04-CMS 1450 Guide to the claims submitted. This ensures that the Facility is in compliance with industry billing standards, and that no duplicate or erroneous charges are applied.

CMN’s review and audit services include:

• Review of medical necessity — that includes procedures, surgeries, medications and durable medical equipment (DME). Charges are cross-referenced with medical records and the claims diagnoses to verify the appropriateness of all charges, codes, units and frequencies related to the patient’s condition and diagnosis.
• Unbundling of charges — is a review of the prevailing charges to determine the level of unbundling that might exist in the bill in the form of separate billing of services that would normally be combined into a single procedure using the proper unbundling references.
• Utilization review — using Milliman & Roberts as our primary guide, our reviews are aimed at verifying the duration of care, and member utilization appropriateness for a given diagnosis. We also identify potential fraud and abuses by cross-linking institutional and professional claims to identify any coding and/or billing anomalies.
• Anesthesia services review — the current American Society of Anesthesiologists (ASA) Relative Value Guide helps us determine the proper reimbursement for anesthesiology services based on: basic unit values, status modifier units, and time units. We apply proper reimbursement rates for professional fees billed separately by either an anesthesiologist or certified registered nurse anesthetist (CRNA).
• Supplies, materials and durable medical equipment (DME) review — confirms the appropriateness of the supplies and materials billed by physicians in accordance with guidelines, as well as verifying the proper reimbursement of customized implants and supplies using prevailing charge references and supplier invoices.
• Determining the room & board reimbursement rate — utilizes our database and other credentialed resources to calculate the actual patient acuity and nursing resources consumption.
• Comparison of charges against the hospital documentation — will exclude any charges that relate to services with improper descriptions and that are not supported by the provided medical documentation.

CMN’s claims management team uses their advanced clinical claims pre-screening capabilities to perform in-depth reviews that flag any potential technical and coding accuracy issues, conduct a reasonable and customary review, as well as reviews various reports and references in negotiating a deeper discount for any bill incurred at a hospital, supplier and other medical care provider that is not part of our preferred provider network. 

This service includes:

• Cost-based negotiations
• Large case prospective negotiations
• Large case concurrent negotiations
• After-the-fact negotiation
• Signed agreements

Contracting and working closely with qualified air ambulance and commercial evacuation providers, CMN directs, consults, and facilitates the safe transport of patients anywhere in the world. Savings from the preferred rates we establish with these contracted carriers are passed directly on to our clients.

We use an online auction tool and obtain at least three competitive bids before selecting a particular carrier, helping ensure our clients receive the highest level of savings.

CMN offers and manages trust accounts for our clients in order to facilitate the payment of claims promptly and accurately, and to help guarantee discounted rates. We have established and strictly adhere to a number of detailed protocols to ensure that client authorization is received prior to any disbursements.

Our clients can opt to receive weekly or monthly account reconciliations.