Bill Review Module

Our Bill Review module is an innovative solution for delivering a paperless electronic bill review environment for the workers' compensation industry, including insurance companies, employers. third-party administrators and bill review companies.

Our Bill Review module is fully integrated with Claims Advantage™ can receive electronic data files via the Internet and automatically processes bills through its repricing engine, generating an EOR and payment EDI back to the Client's Claim System. Bills can be processed directly through the repricing engine or diverted for special handling via a client configurable decision tree.

The software also allows for viewing stored images, such as surgery reports and other supporting documents when the bill review process requires it. The Bill Review module can receive bills via a paper conversion model or from clearinghouses processing electronic bills direct from providers.

System Features

• Three tiers of bill adjudication: dups edits, medical clinical edits, special edits and each line adjudicated against any medical case management authorizations
• Flexible special edits created by user
• Automatic bill re-pricing to the lowest of the billed amount, state fee or PPO amount.
• Build your own fee schedules using Medicare schedules by client/employer
• Build your own state fee schedules and implement by client/employer
• Build your own PPO's or implement your private PPO's online.
• Track savings and amounts to bill to client by line, bill, percent of PPO savings or bill review reduction savings.
• Automatic return to provider via fax of rejected bills with explination cover letter.
• Automatic uploads of claim data to our database
• Automatic downloads of EOB's and bill data or print EOB's
• Check printing available at any printer you choose.
• Complete electronic banking.
• Flexible reporting
• State reporting of bills via X837 IAIABC or state format
• Medical bill data input center provided as a client service saves millions
• This module is integrated into the Claims Advantage™ application and can be used stand alone for bill re-pricers.