Relevant Healthcare provides a national laboratory network that provides savings to its clients on an average of 85% off of billed charges.  As a comparison to those rates, average Medicare reimbursement is approximately 88% below billed charges for Lab.

We provide national coverage offering over 2,100 locations nationwide should a patient choose to visit a draw station, or for even further convenience a patient’s physician can perform the draw in the office as long as the specimen is sent to our network for the analysis.

On average, Laboratory services represents upwards of 4%-4.5% of total medical spend and utilization is approximately 8-9 lab claims per year, per covered life with a billed charge average of $250-$300.  With a savings average of 85% below the billed charge (or on average 30% below a payer’s current charges after PPO discount), Relevant’s Lab Network can offer significant savings via a program that is also extremely easy to implement.

Qualifications:

  • Cannot have a direct, contracted arrangement with our network provider already in place.
  • For Primary Network usage, the payer must add the network logo on the ID card and educate membership and physicians regarding the use of the network when sending out specimens for analysis.  No logo is needed for application to out-of-network claims.
  • Must be able to include specific language on the EOB when sending in payment to ensure proper adjudication and posting of that claim payment.

Process:

  • Any/all lab claims are sent electronically for re-pricing.
  • Claims are re-priced within a 24 hour cycle with appropriate reductions for any in-network claims submitted.
  • All other claims will show as ‘Non-Par’ which can then be sent through the primary PPO to capture a reduction.
  • A monthly savings report and invoice will be provided

Relevant Healthcare can perform a complimentary savings analysis for anyone interested in this program.  Simply provide the last year’s paid claims data for Lab in an Excel format.  Within 3-5 business days, Relevant will supply a detailed analysis of the potential savings.

 

FAQ

Does the member have to go to specific locations to get their blood drawn?
No.  Due to the structure of the program, a patient may have his/her treating physician perform the blood draw in the physician’s office.  Or, if the member prefers, he/she may go to one of the network’s over 2100 draw station locations throughout the country.

Why utilize a program like this for my group health benefits program?
Group health payers can experience up to 85-90+% savings on any/all lab tests.  We have yet to receive any past claims data from an interested payer where we were NOT able to offer significant savings.  Rates in our exclusive, national lab fee schedule have not increased in over 10 years and are nearly as aggressive as the Medicare allowable.

How is Relevant Healthcare able to do this?
Via an exclusive distribution arrangement with our national lab partner, Relevant Healthcare is able to provide access to a very aggressive fee schedule for any/all lab services.  Due to its aggressive nature, our partner will only allow us to offer rates at this level if the payer can meet the requirements noted above in this document.

How much does your service cost?
Relevant can offer its Lab solution under 1 of 2 different models – a PEPM model or a shared savings model, whichever is preferred by the client.  No implementation fees and no fees for any due diligence such as savings analysis or Summary Plan Document reviews.

 

How do we get started?

To implement the program, the payer needs to:

  • Execute a Relevant Healthcare Payer Agreement
  • Create/test an electronic connection to send claim for re-pricing  Add the network logo to the ID cards.  This is to help educate the members’ physicians as to what lab must be used when sending out specimens for analysis.
  • Educate membership and physicians of this new primary lab network.  (Relevant can assist in this area at no cost.)
  • Preferably on a daily basis, all lab claims are sent electronically for re-pricing.  Claims will be returned in an overnight cycle noting any/all claims that ‘hit’ the lab network and resulted in a discount.  Any claims not associated with the lab network will be returned as Non-Par.

How many facilities are in Relevant Healthcare’s nationwide network?
Approximately 1500 facilities in 25 states.  Relevant is also an expert in building free standing networks for our clients in areas where we may not currently have full coverage

What lab tests are available through Relevant Healthcare?
Under the Relevant lab network solution, more than 92% of all 80000 series lab codes are included. Those not covered include various DNA tests and other more complex analysis, many of which are performed under an In-Patient setting. For any lab code that is unable to be priced under the Relevant Healthcare lab fee schedule, the client can simply submit those claims to the general PPO to secure savings.