Comprehensive solutions for property and casualty healthcare payors
Added efficiency and cost-savings for Workers’ Compensation and Auto Medical payorsÂ
Workers’ compensation
Restore productivity for injured workers more quickly and cost effectively.
- 3,900 acute-care hospitals treat injured workers
- 162,000 ancillary care facilities treat injured workers
- 650,000 medical professionals treat injured workers
Auto medical
Get more value from your liability dollars – for you and for your policyholders.
- 3,100 acute-care hospitals treat auto-related injuries
- 109,000 ancillary care facilities treat auto-related injuries
- 600,000 medical professionals treat auto-related injuries
Ensuring healthcare network quality
We contract directly with over 99% of our network providers
We credential providers every three years using nationally recognized accreditation standards, and monitor for quality continuously
Most providers offer discounts below state fee schedules
Our comprehensive data quality program uses data mining, self-service portal tools, and an outbound call center staffed by full-time ³ÉÈËÊÓƵ employees
Case studies
Enhance your bill review with advanced payment integrity
Your bill review program can’t be beat when it comes to applying juris rules and standard edits. You may even incorporate nurse reviews. But provider billing grows more complex every day. ³ÉÈËÊÓƵ’s Payment Integrity services combine automation with clinical review by a board certified physician, certified coder or licensed nurse so that we can target costly, hard-to-catch issues like contradictory or overlapping services, unlikely service combinations and suspect billing patterns.
We fit seamlessly into your bill review process to help you address billing waste and abuse, and deliver an additional 1% to 2% reduction in medical spend.
Containing out-of-network medical spend
Bill repricing with Data iSight
Defensible, highly accepted pricing methodology for bills with no established fee schedule
- Facility bill pricing based on the cost of like providers and medical bills
- Professional bill pricing based on median accepted reimbursement amounts
- Uses geographically adjusted, publicly-available data
- Posts explanations online for complete pricing transparency
Reach agreement using ³ÉÈËÊÓƵ negotiation services
Our 450 negotiators and support staff use sophisticated technology and financial benchmarks to drive success
- Fingertip access to Medicare, bill review allowed, contract rates and Data iSight pricing
- Combines automated and telephonic outreach based on bill size
- Turnaround in 5 or fewer days
- Minimum negotiation amount only $25
Contact us
Improve competitiveness and reduce medical spend. Use ³ÉÈËÊÓƵ’s payment integrity and cost management services to enhance the value of your property and casualty bill review and managed care program.