Alternative Services Concepts, LLC: Managed Care Services

 

Bill Review and Repricing

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

Commercial Property Claims Service, General Liability Claims Service

As a part of this medical bill review and repricing process, the following measures are undertaken:

Commercial Property Claims Service, General Liability Claims Service

  • Bills are screened to verify the accuracy of CPT codes and levels of service Commercial Property Claims Service
  • Uncoded bills are coded or returned to the provider for coding and additional information  Commercial Property Claims Service
  • 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
  • Bills are reduced to the PPO contracted rate if the provider participates in the PPO network workers compensation service
  • 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
  • A computerized explanation of review (EOR) is printed, matched to the provider bill, and returned to ASC

Commercial Property Claims Service, General Liability Claims Service

ASC approves payment of the bill and forwards the EOR, with payment, to the provider. workers compensation claims service, workers compensation claims management service

Each EOR directs provider inquiries to the bill review vendor for resolution. claim service

claims service

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

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