Humana Grows Partnership with Coalition America for Out-of-Network Medical Claim Repricing

Coalition America Inc. (CAI), a provider in medical claim savings, has expanded its relationship with Humana Inc., one of the nation’s largest publicly traded health benefits companies.

In an effort to streamline the repricing and adjudication process for its various insurance products, Humana is connecting electronically with CAI to send out- of-network medical claims and receive repricing information.

“I have enjoyed working with Coalition America and have appreciated their ability to generate savings that we can pass onto our members while being flexible in their approach to meeting our operational and technology needs,” said Alan Wheatley, director of the Market Consulting Practice for Humana Inc. “The ability to work with a vendor that provides streamlined repricing services was a major consideration in our decision to expand our relationship with Coalition America.”

Coalition America, Inc. (CAI) is a provider in medical claim savings utilizing proprietary technology and PPOs (preferred provider organizations) and negotiations to deliver discounts on group health and workers’ compensation medical bills.

Clients interface with CAI through HIPAA compliant EDI (electronic data interchange) or the Internet to reprice in- network and out-of-network medical claims. CAI generates savings through the integration of Primary PPOs, Wrap PPOs, Supplemental PPOs, and direct provider negotiations. CAI has reportedly saved its clients more than $600 million since its inception in 1995.