Medical Bill Review
Quality Bill Review services for the property and casualty market must consist of three elements:
- A sophisticated and flexible software program
- Knowledgeable and experienced Professional reviewers
- PPO administration program that enhances penetration
Then the entire process must be customized to enhance the customer’s unique requirements and technical capability. This is the ReviewWorks formula for enhanced bottom line savings and the long term defensibility of your bill review program.
First Report of Injury
ReviewWorks Rapid Report is our first report of injury product with improved services. We enhance this clerical function of claim reporting and documentation with claim triage to assess and provide timely claim and case management intervention.
Provider Bill Review and Hospital Bill Review
Unlike other bill review "engines" ReviewWorks provider bill review programs are custom built, integrating individual state laws, built in system edits, customized customer specific edits, and experienced medical professionals analyzing medical records in conjunction with the billed service. ReviewWorks consistent use of the latest technologies and service delivery options helps you achieve MAXIMUM SAVINGS AT MAXIMUM SPEEDS, WITH UNPARALLELED ACCURACY!
Utilization Management and Peer Review
Utilization Management assists in controlling rising medical costs by evaluating medical necessity, frequency, compensability and duration of treatment.
The Peer Review process is conducted by ReviewWorks contracted physicians and doctors of the same medical specialty as the treating practitioner who evaluate questionable medical records.
During the professional review process specific medical records and notes may be required to conduct a thorough medical review, ReviewWorks record retrieval process notifies the provider, obtains the records and verifies the information.
ReviewWorks experts negotiate and document additional discounts on out-of-network high dollar Provider and Hospital bills per customer specific guidelines.
Coordination of Medical Benefits
ReviewWorks Coordination of Medical Benefits (CMB) program addresses the claim adjuster's needs to offset benefits paid on coordinated and/or excess policies. Our exclusive CMB program obtains the primary carrier’s explanation of benefits (EOB) forms, computes the balance owed then verifies all Primary Payer activities on our Explanation of Review (EOR) for documentation of your net payment due.
ReviewWorks Professional Review staff responds to provider inquiries and telephonically resolves their issues when possible.