FIRST AID MEDICAL BILL REVIEW

• Most first aid bills are not eligible for payment in full 

• Billings without procedure codes are cross-walked

• Fees for common unlisted procedures are pre-negotiated

• Reasonable charges for necessary charges are recommended

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FEE SCHEDULE MEDICAL BILL REVIEW

• Deadlines and regulatory requirements are closely monitored 

• Procedure codes are matched to level of services

• Unnecessary add-on services are flagged for protocol compliance 

• Reasonable charges for necessary charges are recommended

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EXPERT MEDICAL BILL REVIEW

• Bill review experts add a second set of eyes to high dollar bills

• Additional charges for complications, co-morbidities are carefully inspected 

• Overlapping and medically unlikely coding combinations are corrected

• Reasonable charges for necessary charges are recommended

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PROVIDER FRAUD AND ABUSE DETECTION

• Provider fraud and self-referral reform tools have already been engaged

• Medical Board qualifications and Drug Enforcement Agency licensing are checked 

• Provider fraudulent and abusive billing practices are chronicled

• Reasonable charges for necessary charges are recommended