The record review service provides a review of the medical records including identification of pertinent claim details and missing records. The report provides a case reference table, chronology of events and missing records list. If you are solely interested in knowing what is contained within the records and are not interested in analysis or opinion, this report is for you.
Case Types: Worker's Comp & Civil
Required Records: Medical Records
This medical bill audit compiles all of the medical charges by provider which are reviewed and audited by to establish a reasonable value based on diagnosis codes, standardized fee references, NCCI Edits, correct coding rules. This audit is useful if you are looking for a compilation of charges, a transparent view of the bills and to determine if the bills are “inflated.” This audit uses scientific methodology to establish reasonable value and validation of the charges.
Required Record Type: All billing & statements including insurance EOB's and all medical records
This report combines the record review and med bill audit services into one streamlined report. Charges are substantiated by the record review and inconsistencies within the records are pointed out, including items related to or unrelated to the subject event. If there is over-use (ex: 3 MRI’s within a year) you would see that in the chronology of events. Included in this report is a Provider Summary of the medical bills as well as detailed provider by provider audits summary and a chronological summary of the medical record, allowing you to look for overlapping medical care.
Required Records: All billing & statements including insurance EOB's and medical records
The Claim Evaluation is an intelligent, concise and consistent report interpreting the content of the records. This comprehensive report provides a functional road map to the most productive defense strategy and a clear breakdown of the facts you need for effective negotiation, expediting settlement and reducing indemnity.
Required Records: Medical and Billing Records
The Claim Evaluation is an intelligent, concise and comprehensive report that provides a functional road map to the most productive defense strategy and a clear breakdown of the facts you need for effective negotiation, expediting settlement and reducing indemnity.