Medical Bill Review

Our in-house bill review system combines leading-edge technology with the expertise of our claims adjusters. The automation of our system prevents countless errors which can result from the manual processing of bills and results in enormous savings on medical care. We have developed and built in many flags to automatically disallow payment in instances such as duplicate bills, unrelated treatment, invalid CPT modifiers, maximum procedures per date of service, and others. The bills are also matched to the authorizations on file for the claim to determine if the procedures billed have been authorized when necessary. The process of using these automatic adjustments is the first major step in our mission to reduce the costs of medical bills. Furthermore, if the medical provider is affiliated with our extensive managed care network, additional deductions are automatically taken based on our contract with the provider.

In addition to the automatic review done by our bill review system, the adjusters do a subsequent review to discover any further deductions that can be taken. Following the two-fold review by our bill review system and skilled adjusters, medical bills are either approved for payment or denied according to the workers’ compensation laws and procedures. This two step process of review ensures that the money spent on medical treatment is kept to an absolute minimum.