No more paying retail for out of network care. No more paying for claims that belong to someone else. No more fraudulent claims falling through the cracks. No more ineligible dependents on your plan. Our success with these cost containment solutions are to ensure that you are paying for exactly what you should.

Out of Network Claims Administration - Non-network claims are automatically flagged for review by our Claim Settlement Department. We will help you avoid paying “retail” by looking for a discount that may be available exclusively though SISCO or attempt to negotiate a reduced rate based on our extensive database of utilization data and billing expertise. SISCO's Claim Settlement Unit is able to create an 8% net savings to our clients for every out-of-network dollar that we screen.

Subrogation - To determine the potential for such opportunities, we use established, specific diagnostic codes to identify services that involve a third party or accidental injury. Strong plan document language and expertise in ERISA subrogation rights allow SISCO to recover 87% of every dollar we subrogate. Our performance

benchmark is an average net recovery of $26 for every covered employee on your Plan.

Fraud Detection - SISCO has been a leader in the detection, investigation, and resolution of irregularities or fraudulent actions by providers or employees. We have established procedures and automated systems that are dedicated to identifying potentially fraudulent claims.

Coordination of Benefits (COB) - As part of SISCO's on-going commitment to effective cost management, COB provisions are pursued aggressively at all dollar levels. To make sure that we can administer Coordination of Benefits provisions as effectively as possible, we routinely capture, maintain, and access spousal and ex-spousal coverage and employment data for COB purposes.