Medical Bill Review & PPO ICING

ICS has emerged as a unique national medical bill review alternative for Insurance Carriers, Third Party Administrators, State Funds, and Self Insured Employers by providing flexible service delivery through our proprietary technology and offering access to national and specialty PPO Networks.

By leveraging our managed care, claims, and technology experience ICS achieves significant improvements with an integrated bill adjudication and payment process that creates customized solutions allowing our clients to design a model that provides them with a differentiator in the marketplace and creates efficiencies within their operations.

Our comprehensive information systems and proprietary technology resourcesstreamline operations, communications, data exchange and reporting through web-based portals and direct systems interfaces.  Our advanced processing technology, experienced subject matter experts, and PPO ICING provide clients with savings that are unmatched in the industry.

ICS utilizes the industry leading medical bill review software, SmartAdvisor for the Fee Schedule and Usual and Customary Review (UCR) process.  This system utilizes these highly flexible technologies as the basis for an extremely powerful and robust pricing engine, carefully balancing the efficiency of automated pricing functions with the opportunity for intervention, control, and customization as required to meet the diverse needs of the industry.

SmartAdvisor provides a review of all medical bills including inpatient, outpatient, diagnostic testing, prescription medicine, skilled nursing, home health.   Fee schedules are utilized in all states where required.  ICS also uses DRG grouping software and surgical coding edits.   In non-fee schedule states, ICS utilizes Fair Health for usual and customary pricing.

The reimbursement process for medical bills is made complex by the many considerations that are part of determining the appropriate reimbursement rate for medical services.  These considerations include:

  • State mandated fee schedules
  • Relatedness of treatment or testing to the injury sustained
  • Appropriateness of treatment or testing for the underlying injury
  • Determination as to whether the treatment has been approved within the medical management process
  • Proper coding of the bill

In addition to the proper application of fee schedule reimbursement rates, their workflow and process supports the review of certain bills by medical coding experts and by nurse specialists.  This Code Review process systematically identifies improperly up-coded bills, unbundled procedures, and employs other clinical considerations that result in significant savings beyond fee schedule savings

ICS’ medical bill review and PPO strategy has been developed with extensive managed care “intelligence” and in collaboration with today’s leading workers’ compensation and insurance professionals, the system provides proven “out of the box” capabilities and the flexibility to embody your organization’s unique policies and procedures.  ICS has a phenomenal track record of success in helping clients to:

  • maximize multiple layers of medical cost savings
  • increase accuracy in the medical bill review and re-pricing process
  • leverage expert staff, experienced in bill review, utilization review, and nurse case management
  • ensure appropriate medical treatment is in line with today’s standard protocols
  • improve workflow and efficiency, enabling faster turnaround on bills and prompt payment to providers
  • enable seamless, hassle-free data conversion from previous bill review companies
  • comply with the latest legislative updates to fee schedules and mandated turnaround times to avoid fines and penalties

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Questions?

Our customized Medical Bill Review & PPO ICING service solutions include:

TECHNOLOGY

  • Fee Schedule & UCR Application
  • Capstone Rule Workflow Management
  • Online Approval & Real Time Web Portal
  • Data Integration & Electronic Interface
  • Web based Management Reporting

SERVICE

  • Mailroom & Claim Indexing
  • Document Management
  • Nurse Audit & Code Review
  • Dedicated Account Management
  • Provider Assistance Hotline

To learn more about our services, please call (732)-384-3430