ICS offers litigation management solutions for attorneys, employers, insurance carriers and third-party administrators. Our specialized service assures all related and unrelated medical information are retrieved, placed into a neat chronological package. A specialized report is prepared to address causality, potential barriers and identify essential missing information. Nursing comments can assist claims administration, investigations, and litigation from a medical perspective using our proprietary software system, best practice guidelines and our Subject Matter Expertise.
ICS’ Third-Party Demand Package Review provides a combination of bill review, code review, and nurse review in one complete comprehensive report and includes:
- Software technology (SmartAdvisor) automating the application of rules to determine the correct payment amount tied to a jurisdiction and/or type of claim.
- Certified coders who assist in determining the appropriate fees and procedure codes.
- A team of nurses providing a comprehensive understanding of the injuries presented, treatment involved, and recommendation of charges.
- Services that enhance the understanding the medical claim presented, and in negotiating a fair and equitable settlement.
- A product providing defensible outcomes leveraging the following:
- Proprietary Medical Treatment Calendar
- Explanation of Review & Summary Reports
- Comprehensive Nurse Medical File Review & Audit Report
Tier I: Medical Bill Audit & Analysis
Our customized medical bill audit and analysis is designed to ensure all medical bills are processed in accordance with applicable jurisdictional and regulatory laws. ICS provides review of all medical bills including inpatient, outpatient, diagnostic testing, prescription medicine, skilled nursing, and home health. Fee schedules are utilized in all states where required. ICS also uses DRG grouping software and surgical coding edits. The system contains the NCCI CCI edits (CCE and MUE) and AMA medical edits designed to detect inappropriate coding schemes and automatically disallow these services.
We employ certified coders who review a bill from a code review, diagnosis/procedure crosswalk, and desk audit application which promotes incremental savings for our clients.
Tier II: Nurse Review
When third party claims are complex, insurance carriers benefit by bringing in medical professionals to perform claim reviews. An organization with trained nurses, like ICS, can be an invaluable tool in a third-party adjusters’ toolbox. Not only can a nurse provide detailed analysis of the claim and flag issues, but they also can help prepare the adjuster to successfully explain and negotiate complicated medical issues. The true value of nurse review is to provide comprehensive results that greatly impact the final settlement paid. When a nurse review is performed correctly, it can help insurance companies achieve significant cost containment on third party claims.
