Medical Bill Review

Vigilance toward fairness and accuracy

We review over 2.5 million medical bills containing over $1 billion in medical costs each year. With such large costs at stake for our customers, we use a combination of rules-based system technology and medical professional intervention to ensure fairness and accuracy.

All medical bills go through our bill review system that performs the following:

• Prices bills based upon fee schedules, fair and reasonable allowances and state guidelines
• Interfaces with PPOs to ensure timely and accurate contractual reductions in cost
• Performs online utilization review to ensure the type and number of services are in line with the reported diagnosis
• Identifies duplicate submissions to avoid duplicate payments

For high dollar amount or complex bills, a medical professional with expertise and training in medical review auditing and state-specific guidelines performs a line-by-line review.  They review for items such as:

• Relationship to the compensable workers' compensation injury
• Fairness for billed services
• Discrepancies between billed charges and services documented
• Negotiation of appropriate non-PPO charges