Claims Management Services
Medical Bill Review and Cost Containment Program
Did you know medical costs of a claim typically absorb 60% of your overall claims dollars paid? Let us show you how FFVA Mutual can significantly increase the medical savings on your claims. We use an in-depth medical bill review process that ensures proper payment, treatment accuracy, and regulatory compliance.
Industry Standard Review
- Review for duplicate billings
- Identify unbundling of procedures
- Apply proper procedure coding
- Apply fee schedule, usual and customary reductions, medical limits, and regulatory rulings
FFVA Mutual's In-House PLUS+ Review
- Includes all Industry Standard Review components
- PLUS+ review for proper use of coding modifiers
- PLUS+ apply network or contractual reductions
- PLUS+ validity edits for required EDI data
- PLUS+ compare diagnosis/relatedness to medical records
- PLUS+ apply negotiated discounts by our physician advisor
- PLUS+ conduct utilization review for over-utilization, Rx use
- PLUS+ apply National Guidelines-Medicare NCCI and ODG edits
