Bill Review and Repricing - Workers Compensation Claims Management
Commercial Property Claims Service, General Liability Claims Service
Provider bill review services ensure that
medical bills are reviewed and adjusted quickly and accurately.
In addition to reducing bills to a fee schedule or usual
and customary rate, the review provides additional cost
savings, incorporating discounts through PPOs and pharmacy
programs, as well as out-of-network hospital and facility
charge reviews. workers compensation service, property claims TPA, Commercial Property Claims Service, General Liability TPA claims
As a part of this medical bill review and
repricing process, the following measures are undertaken:
Commercial Property Claims Service, General Liability Claims Service TPA
- Bills are screened to verify the accuracy of CPT codes
and levels of service workers compensation Claims Service t
- Uncoded bills are coded or returned to the provider
for coding and additional information Commercial Property Claims Service, TPA claims
- Bill data are captured through scanning/OCR technology
or by trained/experienced PBR analysts
- Duplicates are identified and returned at no charge
- Fees are compared against the fee schedule or usual
and customary database Commercial Property Claims Service, TPA claim services
- Bills are reduced to the PPO contracted rate if the
provider participates in the PPO network workers compensation TPA service, TPA claims
- Out-of-network bills meeting certain criteria are electronically
selected and routed via EDI for review or negotiation
- High-impact bills are reviewed by senior-level auditors
to ensure that all possible savings are achieved TPA claims administration, Claim service
- A computerized explanation of review (EOR) is printed,
matched to the provider bill, and returned to ASC liability claims TPA, claims service
Commercial Property Claims Service TPA, General Liability Claims Service TPA
ASC approves payment of the bill and forwards
the EOR, with payment, to the provider. workers compensation TPA
Each EOR directs provider inquiries to
the bill review vendor for resolution. claim service TPA
Highly sophisticated software systems and
a technically proficient medical review staff facilitate
the delivery of the most comprehensive, professional, and
highest quality reviews available in the industry. Bill
review services are uniquely designed to achieve savings
on virtually any type of medical bill.
workers compensation TPA
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