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EthiCare Advisors is now part of
Zelis® Healthcare.

Visit the Zelis Healthcare website to learn more

“It ain’t braggin’ if you can back it up.”
Jay Hanna “Dizzy” Dean
St. Louis Cardinals, Hall of Fame Pitcher

Actions speak louder than words and our proven ability to save claim payors money on high-dollar medical claims speaks for itself.

High-Dollar
Claim Savings

The cost of healthcare continues to rise with no indications of slowing down. A recent PriceWaterhouseCoopers study revealed an 84% increase in the last 10 years. Combined with the dramatic increase in $1M claims, it’s no wonder claims payors are seeking proven cost-saving solutions.

Dialysis
Claim Savings

We’ve been settling dialysis claims for years and our proven ability is backed up by solid savings and countless client referrals. We don’t simply use automated software to arrive at claim savings, we employ a variety of hands-on approaches to controlling high-cost dialysis treatment.

Dialysis
Claim Savings

We’ve been settling dialysis claims for years and our proven ability is backed up by solid savings and countless client referrals. We don’t simply use automated software to arrive at claim savings, we employ a variety of hands-on approaches to controlling high-cost dialysis treatment.

Our Strategy

$1M claim frequency has increased 1,000% since 2010

Our three-tiered approach to saving claim payors money ensures a comprehensive effort is made on every referral to secure the most savings possible.

Our most effective approach is to negotiate settlements directly with providers. We’ve never had a settlement rescinded!

Some providers just won’t settle, so our expert coders pour through billed charges with a Medical Bill Review, many times uncovering coding errors, unbundling and even fraud.

Another tactic is to leverage our team of financial & insurance experts, who continually monitor Usual & Customary fees and ensure our clients are not overpaying for services.

Additional Services

DRG/APC Validation Reviews

  • Assist claim payors adjudicating claims based on DRG/APC
  • Verify the accuracy of provider’s DRG/APC assignment
  • Provide pricing information (Upon verification)
  • Validation report containing correct codes for incorrect provider DRG or APC

Medical Underwriting (“Laser”) Reviews

  • Effective underwriting/disclosure and risk assessments
  • Hands-on disclosure review evaluating nuances and commonly overlooked details
  • Expert team with decades of clinical, risk management and insurance experience
  • Efficient 2-3 business day turnaround

HIPAA Compliance

  • Security risk assessments
  • Customized policies and procedures
  • Employee training
  • IT security
  • Breach investigation

Expert Witness

  • Healthcare reimbursement
  • Stop-loss/reinsurance
  • End-stage renal disease
  • Dialysis reimbursement
  • Self-funding
  • Medicare secondary payor regulations

Claims Consulting

  • Pre-existing condition reviews
  • Non-disclosure reviews
  • Medicare set-aside allocation analysis
  • Special projects

Start Saving 888.838.4422
Savings@EthiCareAdvisors.com

Send Us a Referral

Email
Savings@EthiCareAdvisors.com

Secure Fax
866.662.4121

Electronic Data Interchange
Via Secure File Transfer Protocol (SFTP)

Mail/Courier
ATTN: Claims
EthiCare Advisors
22 Route 10 West
Suite 201
Succasunna, NJ 07876

Affiliations

Contact Us

Our Address

22 Route 10 West
Suite 201
Succasunna, NJ 07876

Our Numbers

888.838.4422
866.662.4121 (fax)

About Us

We save claim payors money.  Period.  Our expertise and experience settling high-dollar and dialysis claims through negotiated sign-offs, medical bill review and U&C pricing has positioned us as a trusted partner for employers, labor funds, TPA’s and carriers.  We have a long record of success in negotiating high-dollar, in-network and out-of-network claims and can proudly state that no EthiCare Advisors negotiated settlement has ever been rescinded by any provider. It’s our mission to save claim payors money and our hands-on approach to each referral is the key to our success. Frustrated with high-dollar claims?  We can help.