Medical Bills. Expertly Reviewed.

Every Dollar Counts. Medical costs typically amount to 60% of claim dollars paid.

Our medical bill review process reduces claim costs, which directly impacts premium and employer experience modification rates. Last year, we reviewed more than 55,000 medical bills that resulted in over $40 million in savings.

Benefits to Employers

  • Hands-on approach maximizes savings at no additional cost
  • No upfront pharmacy charges
  • Lower costs based on our PPO networks and negotiated medical bills
  • Timely payments to medical service providers
  • State regulation compliance

 

Eliminating Overpayments Creates Savings

How We Do It

  • Compare usual and customary pricing
  • Evaluate diagnosis related to medical records
  • Examine medical records for accurate bill coding and review code modifiers
  • Follow national guidelines: Medicare, NCCI, ODG
  • Identify bundling procedures
  • Maintain accurate billing practices and state regulatory updates through consistent staff training
  • Monitor for duplicate billings
  • Utilize medical limits and rulings