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The medical bills can be processed through our PrimeCare Health Services Group Inc.
Bill Review automated auditing system to determine the maximum amount
of savings to be realized on each bill. Bills are processed against (as
appropriate) fee schedules, usual & customary data bases,
traditional PPO discounting (using multiple PPO networks) and now the
new Managed Provider Network systems. Bill review processing can
provide savings of 10 to 55% or more depending on the type of bill and
location of service. PCHSGI Specializes in the review of ambulatory
surgery centers and hospital charges with costs that are capped.
Provider bills which can be review/audited include:
- physicians
- chiropractors
- laboratories
- physical therapists
- psychologists
- acupuncturists
- dentists
- hospitals
- ambulatory surgery centers
- durable medical equipment
A bill review will identify:
- Billing accuracy, to identify duplicate charges, incorrect charges or data entry errors;
- Utilization issues such as excessive or inappropriate treatment/testing;
- Charges that are inconsistent with State Fee Schedules or usual and customary charges; and
- Upcoding and Unbundling of charges.
Claims management alert reporting will identify:
- Diagnoses indicating catastrophic injury or disease which may require immediate medical management;
- Time elapsed from date of injury indicates possible need for medical/vocational intervention;
- Frequency/duration of treatment indicates possible over-utilization, and need for medical review;
- Existence of the possibility for first- or third-party recovery; and
- Insurer-selected utilization (treatment) thresholds are exceeded.
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