Healthcare Horizons Information

Healthcare Horizons Consulting Group, Inc. is a leading expert in providing healthcare claims audit services and assessing the performance of claims payers through our 100% Difference model. Since 1999, our comprehensive claims audits and out-of-network fee negotiation services have been protecting the financial interests of some of the world’s largest self-insured employers. One of the unintended consequences of self-insuring is that claims payers have no financial incentive to control costs. We help our clients manage healthcare expenses and keep costs in check. At Healthcare Horizons, we make it right. • The 100% Difference means we turn over every stone. Random sample audits will not look at every claim, possibly leaving thousands of dollars paid in error. Our comprehensive audits review 100% of claims paid, analyzing all claims data to find errors. The recovered dollars are returned to YOU. • Our executive team is involved in every audit, and our expert data review process triggers the creation of custom queries for "best probable error" selection, identifying more systemic errors and ensuring long-term savings for our clients. • We test areas such as benefit maximums and exclusions that could impact members if recovery is initiated, and we alert employers so they can make recovery decisions. You are in charge, and you determine which claims to recover. We work with your TPA to monitor collections and help negotiate credits or settlements. Healthcare Horizons has built excellent working relationships with external audit coordinators at every national TPA across the country. Our team has identified millions of recoverable dollars for our clients since 1993.