Medical Bill Re-Pricing
Bill Re-pricing PDF Print E-mail
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Tuesday, 10 February 2009 12:02

Bill Re-pricing

Are your medical costs out of control?

Need to substantiate a denial of potentially unnecessary medical treatment?

Need documentation to settle a claim?

 

Our state of the art Medical Bill re-pricing system works as an integral part of our overall claims cost containment process.

 

Our system provides helpful tools for claims management. Each claim is monitored, and compared to predictive medical standards and outcomes. The system tracks all information, and produces needed reports. Avoid paying duplicate bills and achieve savings by reducing bills to state fee schedule or PPO discounts.

All bills will be:
  • Processed and returned within 3 business days of receipt
  • Processed under the appropriate jurisdictional rules and schedules
  • Reviewed for appropriateness of care
  •  Reviewed for utilization

While payment may not be denied based solely upon over utilization, a warning will appear on the EOB.

This warning alerts to potential over treatment and requests objective documentation from the provider

  •  Checked for duplicate billing and services embedded within another bill
  •  Reviewed for level of service

Many times providers will submit billing for a level of service that does not correlate to the severity of the injury

  •  Adjudicated using the following ClinicalEdits and CPT Guidelines:   

                    1. CCI (Correct Coding Initiative)                                         
                    2. Heat (supported by medical literature)                                 
                    3. Rarity (supported by provider billing)
                    4. Utilization (supported by provider billing)

 

State of the Art

Scanning Capabilities
Bills are sent to The SRS Group and scanned into a workflow management process and real
time reporting system.
Explanation of Benefits
We provide an itemized EOB that complies with the rules and statutes of the appropriate
state.
PPO Networks
We utilize Aetna and First Health PPOs and other networks.
Monitoring and Updating
We are committed to monitoring and updating changes to the state fee schedules.
Available Reports and Distribution
The SRS Group has the capability to create countless customized reports.
Disaster Recovery and Redundancy Procedures
We house all mission critical servers in a secure facility.
Storage Modules
All data is stored internally to the software in a proprietary format.
Maintenance and Updates
Nightly backups on all data; Software and fee schedules are updated monthly.
Access to Medical Bill Data
Access to medical bill data is through a secure website.
Dedicated Help Desk
We have a dedicated call center for handling customer inquiries.
Last Updated on Thursday, 16 April 2009 17:07