Bill Re-pricing

Are your medical costs out of control?

Need to substantiate a denial of potentially unnecessary medical treatment?

Need documentation to settle a claim?

Our state of the art Medical Bill re-pricing system works as an integral part of our overall claims cost containment process.

Our system provides helpful tools for claims management. Each claim is monitored, and compared to predictive medical standards and outcomes. The system tracks all information, and produces needed reports. Avoid paying duplicate bills and achieve savings by reducing bills to state fee schedule or PPO discounts.

• Processed and returned within 3 business days of receipt

• Processed under the appropriate jurisdictional rules and schedules

• Reviewed for appropriateness of care

•  Reviewed for utilization

While payment may not be denied based solely upon over utilization, a warning will appear on the EOB.

This warning alerts to potential over treatment and requests objective documentation from the provider

•  Checked for duplicate billing and services embedded within another bill

•  Reviewed for level of service

Many times providers will submit billing for a level of service that does not correlate to the severity of the injury

•  Adjudicated using the following ClinicalEdits and CPT Guidelines:   

                    1. CCI (Correct Coding Initiative)                                         
                    2. Heat (supported by medical literature)                                 
                    3. Rarity (supported by provider billing)
                    4. Utilization (supported by provider billing)

State of the Art