Cost Containment and Bill Review
By combining state of the art technology with analyst oversight, we are able to provide client's with unsurpassed "Total Net Value".  After processing data through our software platform to meet required parameters, every bill is subject to a rigorous analytical review by our skilled analysts (with an average of 15+ years experience).  What does "Total Net Value" mean to you?
  • Higher gross savings with experienced analyst review
  • Quality assurance resulting in low error ratio
  • Improved turnaround time and lower risk of penalty
  • High client satisfaction with quick response rate and access to senior management
  • Customized workflow that reduces clerical and admin requirements, including:
    - EDI interface
    - Scanning capabilities
    - Electronic document storage and retrieval
    - Integration with most medical management and utilization review programs
    - Multiple PPO's from which to select

Utilization Review Services
 Recent legislation in California and other states has increased the impact the Utilization Review (UR) can have on your bottom line.

Read about our accepted clinical review criteria ...
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With a staff of licensed clinical professionals and a process that focuses on effective communication among all parties involved in the claim, our Utilization Review service:
  • Reviews prospective, concurrent and retrospective treatment requests for medical necessity and appropriateness.
  • Provides turnaround times that exceed state mandated times frames, where applicable.
  • Ensures that requested treatment does not conflict with planned direction of the claim by assigning nurses to work closely with adjusters.  Additionally, issues such as denied body parts, ongoing investigation, and litigation are discussed prior to review.
  • Links telephonic and Utilization Review management with bill review software
Read about our Telephonic Case Management  ...
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