Bill Review & Repricing

CareWorks MCS' medical bill review service ensures that medical bills are reviewed and adjusted quickly and accurately.

Bills are reviewed and all fee schedule or usual and customary discounts are automatically deducted. After all discounts are deducted, a PPO discount is applied if the provider is participating in one of the PPO networks.

Measures Taken

As a part of this medical bill review and repricing process, the following measures are also taken:

  • Bills are screened to verify CPT code accuracy and service levels
  • Uncoded bills are coded or returned to the provider for coding and additional information
  • Duplicates are identified and returned at no charge
  • Out-of-network bills meeting certain criteria are electronically selected and routed via EDI for review or negotiation
  • High-impact bills are reviewed by senior-level auditors to ensure that all possible savings are achieved
  • A computerized explanation of review (EOR) is printed, matched to the provider bill, and returned to ASC
  • ASC approves payment of the bill and forwards the EOR, with payment, to the provider
  • Each EOR directs provider inquiries to the bill review vendor for resolution

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Highly sophisticated software systems and technically proficient medical bill processors facilitate the delivery of the most comprehensive, professional, and highest quality reviews available in the industry.

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"ASC has shown itself to be experienced, professional and humane, and these are the exact qualities I expected in claims administration." Pike County Schools, Kentucky