​Specialized Networks and Care Management Services

Access to organizations for care management services and specialty networks with contracts for services with leading university and medical centers for:

• Transplants (access to four national networks at discounted rates)
• Congenital Heart Disease
• Cancer
• Kidney Disease
• Bariatric Services

Disease Management

Services and resources to assist health plans and other risk-bearing organizations with managing high-cost, complex, chronic medical conditions.

• RGA has contracted with organizations that provide expertise, resources and coordination with disease management vendors based on your needs.
• As an RGA client, you will have access to expert consultants, resources and competitive pricing at a fraction of the cost of directly accessing these services.

High-Cost Drug Discounts

Pharmacy vendors that provide competitive discounts for high-cost medications that are necessary for the care and management of patients with:

• Hemophilia
• Growth Hormone Deficiency
• Cancer
• Multiple Sclerosis
• Gaucher's Disease
• Hepatitis
• Organ Transplants
• Other chronic conditions not limited to those listed

Reducing Claims Costs - Pre-Payment

Discount opportunities prior to claims payment

National Repricing Networks

Reprice and reduce out-of-network medical claims for hospital, physician and ancillary services. Due to the volume of claims they process, these networks are able to obtain discounts from more than 1 million health care providers across the United States, and out-of-country.

Medical Bill Negotiation Services

Case-by-case negotiations by experienced negotiation specialists to obtain discounted rates for hospital and professional services without the use of national networks.

Reducing Claims Costs - Post-Payment

Potential claim discounts after payment has been made

Medical Bill Audit Services

Review of medical bills suspect for inaccurate/inappropriate charges, using a comprehensive database of usual and customary charges. In addition, provide negotiation services to recover losses due to errors uncovered from audit results.
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