Medical Bill Review

Our provider bill review process is as comprehensive and efficient as any in the marketplace. Using the most robust and flexible software available in the industry today, it has the ability to:

• Upload fee schedule revisions for each state as they are released, thus insuring both regulatory compliance and maximum savings;
• Receive timely electronic updates of Ingenix, a nationally recognized geo database for usual and customary bill review; and
• Improve workflow processes by using Optical Character Recognition (OCR) and document management integration technology, thereby minimizing turnaround time.

This enabling technology permits us to offer our clients:

• The elimination of excessive charges;
• The elimination of duplicate charges;
• The identification of billing infractions; and
• The ability to write customized rules for each customer to identify and divert predefined bills for certain injury and/or procedures to a nurse case manager for review and challenge.

Following the review process, all provider bills, medical attachments, and Explanation of Review (EOR) images are integrated into our online claims center.