Medical Cost Containment

Medical cost containment

Medical Bill Review/Repricing

Medical Bill Review/Repricing is an automated process that assists our clients with making appropriate payments on medical bills. Appropriate payments are identified utilizing applicable state fee schedules as specified by state laws, and by a Reasonable and Customary database (built on a defensible national database based on geo-zip codes).

  • Timely bill turnaround
  • Application of Preferred Provider Organization contracts
  • Experienced Bill Reviewers identify questionable diagnostic codes, procedure codes and bills requiring additional review
  • Experienced Registered Nurse available for consultation
  • Retention of two-year history, providing foundation for checking bill duplication
  • Formal reconsideration process
  • Savings analysis reports

Provider Bill Review

Provider Bill Review services conduct an analysis of provider bills where medical issues must be considered in evaluating the provider’s services.

  • Maximizes cost savings
  • Considers duration and appropriateness of treatment, diagnosis, intensity of service, unrelated charges and medical necessity
  • Recommends peer review when appropriate
  • Identitfies unbundled charges, experimental treatment, unusual billing practices and inappropriate use of CPT codes
  • Provides savings on recoded multiple surgical procedures

Hospital Bill Review/Negotiations

Hospital Bill Review/Negotiations services have been very successful in assisting our clients with determining appropriate payment as well as negotiating where other savings are not available or are negligible. The professional review provides valuable information in a concise format.

  • Timely turnaround
  • Knowledge and experience with state laws governing Workers’ Compensation
  • Negotiation services within your parameters
  • Diagnosis, severity of illness, intensity of service, and evaluation for unrelated charges.
  • Identification of inaccurate or medically inappropriate chares
  • Dispute resolution

PPO Networks

The PPO Network includes physicians, facilities, providers, home health services, pharmacy and durable medical equipment. Providers are screened for quality of service, price, and accessibility. Use of these networks results in additional savings to our clients beyond the state fee schedules and beyond usual and customary prices.

  • Pre-negotiated contractual savings
  • PPO discount applied during bill repricing process
  • Names of out-of-network providers may be submitted for solicitation to join PPO
  • Employers may choose to use listing of PPO members to direct care
  • Pharmacy Direct Pay PPO service available



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