Control Healthcare Costs Without Compromising Care
Globalwide's cost containment programme combines clinical expertise, proprietary pricing data, and rigorous audit processes to deliver measurable savings on every claim — without restricting access to quality care.
Data-Driven. Clinically Grounded.
Healthcare cost management requires more than rule-based adjudication. It demands clinical judgement, market intelligence, and the ability to identify overcharging, fraud, and unnecessary utilisation before payment is made. Globalwide's cost containment team applies all three — combining our proprietary medical pricing database with in-house physician review and advanced analytics to protect our clients' healthcare spend.
Every Lever for Healthcare Cost Control
From the moment a claim is submitted to final payment, Globalwide applies a comprehensive set of cost containment tools.
Provider-Rate Benchmarking
Every provider's billed charges are compared against our continuously updated medical pricing database — covering 150+ countries.
Hospital-Bill Audit
Inpatient hospital bills are audited line by line — checking for unbundled charges, inflated room rates, duplicate items, and services not rendered.
Laboratory-Price Comparison
Laboratory charges are benchmarked against market rates and our contracted lab network. Overpriced tests, unnecessary panels, and duplicate orders are identified.
Pharmacy-Cost Review
Pharmaceutical claims are reviewed for appropriate prescribing, generic substitution opportunities, and pricing against international reference prices.
Negotiated Discounts
Our network agreements include pre-negotiated rates for the most common procedures and services.
Fraud Detection
Automated pattern analysis and manual review identify fraudulent billing — including phantom services, provider collusion, identity fraud, and systematic upcoding.
Duplicate Billing Review
Our system automatically detects duplicate claims across all submission channels — same provider, same member, same date of service, same procedure.
Utilisation Review
Planned admissions, extended stays, and high-cost procedures are reviewed against evidence-based clinical criteria before authorisation.
High-Cost Case Management
Cases exceeding defined cost thresholds are assigned a dedicated case manager — a qualified clinician who oversees the care pathway.
Medical Necessity Review
Claims for specialist referrals, elective procedures, and extended treatment are reviewed against clinical guidelines to confirm medical necessity.
International Price Comparison
For cross-border treatment and medical tourism cases, our international pricing database provides benchmark costs for procedures in every major healthcare market.
Claims Analytics
Comprehensive analytics across the full claims portfolio identify cost trends, high-utilisation providers, emerging fraud patterns, and opportunities for benefit design improvement.
Cost Containment at Every Stage
Pre-Authorisation
Utilisation review and medical necessity checks before care is delivered — preventing unnecessary treatment and ensuring appropriate level of care.
Concurrent Review
Active case management during inpatient stays — monitoring length of stay, coordinating discharge planning, and managing high-cost cases in real time.
Claims Adjudication
Line-item review, coding validation, duplicate detection, and pricing benchmarking applied to every claim before payment is approved.
Post-Payment Audit
Retrospective review of paid claims identifies overpayments, billing errors, and fraud — with recovery processes initiated where appropriate.
Analytics & Reporting
Ongoing portfolio analysis identifies trends, flags emerging risks, and provides clients with actionable intelligence for benefit design and network management.
Pre-Authorisation
Utilisation review and medical necessity checks before care is delivered — preventing unnecessary treatment and ensuring appropriate level of care.
Concurrent Review
Active case management during inpatient stays — monitoring length of stay, coordinating discharge planning, and managing high-cost cases in real time.
Claims Adjudication
Line-item review, coding validation, duplicate detection, and pricing benchmarking applied to every claim before payment is approved.
Post-Payment Audit
Retrospective review of paid claims identifies overpayments, billing errors, and fraud — with recovery processes initiated where appropriate.
Analytics & Reporting
Ongoing portfolio analysis identifies trends, flags emerging risks, and provides clients with actionable intelligence for benefit design and network management.
The Competitive Advantage of Proprietary Data
Proprietary Pricing Database
Built from real claims data across 150+ countries — no external database can match the depth and currency of our pricing intelligence.
In-House Clinical Team
Physician and nurse reviewers embedded in our cost containment process — clinical judgement applied where it matters most.
Fully Auditable
Every cost containment decision is documented, timestamped, and traceable — supporting regulatory compliance and client reporting.
Measurable Savings
We report cost containment outcomes in detail — showing clients exactly how much was saved, on which claims, and through which interventions.
Ready to Reduce Your Healthcare Costs?
Talk to our team about how Globalwide's cost containment programme can deliver measurable savings for your health plan or insurance product.
Request a Proposal