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Claims Evaluation Tools

Medical-Records-Review

Record Review

Complete evaluation of records, including organization, chronology and list of missing records.

medical-bill-audit

Medical Bill Audit

Compilation of all medical charges that establishes reasonable value and validation of charges.

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Medical Bill Audit & Record Review

Streamlined audit and report pinpointing medical record inconsistencies in billing and chronology.

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Claim Evaluation

Intelligent report interpreting record content. Provides a functional road map for defense strategy.

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Record Review Overview

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.

Required Records

Required Records: Medical Records

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Compare the Features

Features Record Review Record Review Report Claim Evaluation
Chronological list of pertinent events
Pertinent missing records list
Case overview
Provider list without billing    
Provider list with bill compilation with total vs. paid  
Provider list with medical bill audit summarizing total paid, total adjusted, total paid by patient, and balance due    
Current medical treatment and prognosis  
Claim assessment (strengths and challenges)  
Medical Bill Overview  
Potential future medical care  
Future care costing  
Evaluation conclusion  
Demand evaluation    
Records Required Medical Records Medical & Billing Records
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Medical Bill Audit Overview

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 Records

Required Records: All billing & statements including insurance EOB's and all medical records

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Compare the Features

Features Medical Bill Audit Medical Bill Audit MBA Record Review MBA & Record Review
Organized charge data
Billing totals
Total reasonable value
Review for duplication
Review for related versus unrelated charges
Audited using standardized fee reference methodology
Audited using standardized fee reference methodology with application of geographic modifier
Line item commentary to explain reductions
Compilation of amount paid, adjusted, paid by patient, and balance due
Review of medical record to substantiate services provided as necessary for MBA completion
Medical records summary and chronology of pertinent events  
Evaluation conclusion  
Analysis of all providers and their charges    
Records Required All billing & statements including insurance EOB's and all medical records All billing & statements including insurance EOB's and medical records
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 med-bill-audit-record-review

Medical Bill Audit & Record Review Overview

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

Required Records: All billing & statements including insurance EOB's and medical records

Learn More

Compare the Features

Features Record Review Medical Bill Audit Record Review MBA MBA & Record Review
Organized charge data
Billing totals
Total reasonable value
Review for duplication
Review for related versus unrelated charges
Audited using standardized fee reference methodology
Audited using standardized fee reference methodology with application of geographic modifier
Line item commentary to explain reductions
Compilation of amount paid, adjusted, paid by patient, and balance due
Review of medical record to substantiate services provided as necessary for MBA completion
Medical records summary and chronology of pertinent events  
Evaluation conclusion  
Analysis of all providers and their charges    
Records Required All billing & statements including insurance EOB's and all medical records All billing & statements including insurance EOB's and medical records
  Learn More Learn More
 claim-evaluation-tool-1

Claim Evaluation Overview

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

Required Records: Medical and Billing Records

Learn More

Compare the Features

Features Record Review Record Review Report Claim Evaluation
Chronological list of pertinent events
Pertinent missing records list
Case overview
Provider list without billing    
Provider list with bill compilation with total vs. paid  
Provider list with medical bill audit summarizing total paid, total adjusted, total paid by patient, and balance due    
Current medical treatment and prognosis  
Claim assessment (strengths and challenges)  
Medical Bill Overview  
Potential future medical care  
Future care costing  
Evaluation conclusion  
Demand evaluation    
Records Required Medical Records Medical & Billing Records
  Learn More Learn More

What Is Claim Evaluation?

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.

 

Claim Evaluation Is Also...

  • Your blueprint for an actionable defense
  • A tool to utilize when demand packets are sent
  • Identifies facts in the records needed to design the most effective case strategy
  • Ensures records hold no suprises for the case by reading between the lines for inconsistencies in the medial history, or missing information
  • Spend less time planning and more time moving towards resolution