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Claim Evaluation Tools

Medical-Records-Review

Record Review

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: Medical Records

medical-bill-audit

Medical Bill Audit

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

medical-records-review-audit

Medical Bill Audit & Record Review

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

claim-evaluation-report

Claim Evaluation

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

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