Aggressively managing claims, controlling costs and exceeding your expectations is our goal.
This requires commitment to processes, flexibility to meet unique customer needs, and expert knowledge that can only come from decades of industry experience.
We work with insurance companies, individual and group self insureds, third party administrators, attorneys, employers and municipalities to control medical costs while ensuring quality and compliance and facilitating recovery from injuries.
Contact our Medical Review Services to see how we can help you.
Client-specific & automated rules processing
We utilize sophisticated algorithms to ensure consistency and have years of experience to ensure high quality results when it comes to medical bill review. From applying all available discounts to identifying when an auditor is needed, we customize our cost containment services to the needs of every client.
To optimize efficiency and avoid mail room delays, our process is paperless – using EDI or scanning to optimize efficiency. Bills can be reviewed and approved online. Reports can be accessed 24/7 through the client portal on our website.
Our highly knowledgeable and experienced bill reviewers employ multiple layers of analysis for every bill to ensure accuracy, prevent duplicate charges, and identify causal relationships.
When the complexities of medical billing are furthered by coordinating benefits across multiple providers, we have the knowledge and the experience needed to control costs for you. We also have the tools in place to re-price according to Medicare rules and regulations.
Network Savings through wide network usage
In addition to expert bill review, our extensive experience with PPO networks and out-of-network negotiations offers additional savings potential.
Expert Negotiations. Extra Savings
Negotiating means more savings for you. As an added benefit, we offer expert negotiation for all out of network bills that receive no savings through the normal bill review process.
Effective medical bill review that has a serious impact on your bottom line requires the ability to know when additional review or an auditor is needed. The sophistication of our processes and technologies and the knowledge and experience of our audit team is unmatched.
We offer the following services with flexibility and scalability to meet your specific needs:
Multiple layers of PPO Networks
State Fee Schedules
Coordination of Medical Benefits
Analysis of Codes billed for accuracy
Out-of-network negotiation services