Our bill review provides a review only of medical bills so that our clients are able to determine the actual cost of treatment. This information is used for settlement purposes or to determine actual value of the medical portion of the claim.

Medical bills are reviewed to achieve optimum cost containment. We use a tiered approach that allows for the advantage of sophisticated bill review software, information management technology and various data sources, along with an expert team of bill review specialists, certified coders and medical professionals experienced in detailed review of medical bill charges and treatments. The level of service used is determined by the complexity of the case and legal involvement.

Levels of Service

First Level Review by Bill Review Specialist

  • Comprehensive coding review, and bill re-pricing
  • Usual, customary, and reasonable review
  • Duplicate detection
  • Fraud detection
  • Utilization review
reviewer

Second Level Review by Nurse, Physician, Legal

  • Extensive line by line audit of high dollar bills
  • Recommended for bills greater than $10,000 in provider charges
  • Ensures treatment is documented in medical record
  • Careful review of surgical codes, pharmacy and DME charges
  • Review of implants and biologics
  • Up-coding review
  • Identifies discrepancies
  • Reviews medical bill and treatment records to determine if treatment is reasonable and necessary
  • Physicians and coding experts are available for deposition or testimony in all states