Medical Bill Re-pricing

• Fee schedule review
  • All fee schedule states
    
• Usual and customary review
  • All non-fee schedule states
    
• Preferred provider discounts
  • Non-hospital
  • Hospital inpatient
  • Hospital outpatient
  • Ambulatory surgery centers

   

Preferred Provider Networks

• Non-hospital providers
  • Primary treating physicians
  • Ambulatory surgery centers
  • Industrial clinics
  • Specialists
  • Physical therapists
  • Chiropractors
  • MRIs
  • Other ancillary
    
• Hospital facilities
  • Inpatient
  • Outpatient

Utilization Review

• Pre-authorization of admission and treatment
• Concurrent review
• Second surgical opinion
• Discharge planning
• Peer review
• Physician advisor network

Case Management

• Telephonic case management
• Field case management
• Direction of care