The bill review program you choose can have a significant impact on how much your organization spends and saves. Our customized and comprehensive approach to bill review has a proven performance record of outstanding results united with excellent customer service. We place special emphasis on extensive discounts partnered with quality assurance that results in an unparalleled level of cost savings.
The scope of First MCO’s Bill Review services include but are not limited to:
- Re-pricing – Applicable pricing utillizing PPO network, UCR or Negotiation
- Utilization Management – Review of treatment for appropriateness
- Out-of-Network Negotiations – Work with out-of-network providers to obtain signed agreements for best pricing
- Audits/Surgical Review – Review of documentation to ensure validity and compensability
Extensive discounts, partnered with quality assurance bill review, result in decreased medical costs. Our Network discounts help control cost to the employer. We have generated an average of 65% percent in net savings for our clients.
First MCO Advantage:
- EDI capability – Incorporate bill review data with the claims administration database
- Bills are checked and validated for services provided
- Extensive PPO and specialty network affiliations is most effective in maximizing cost reductions
- Seamless integration with bill review procedures and utilization management to provide correct treatment authorization information for our case managed accounts
- Thorough review of services by highly experienced bill reviewers to identify all unauthorized charges, duplicate billing, upcoding, unbundling and disallowed fees
- Utilize state-of-the-art and customized software that assists in the review of bills
- Cost-analysis and customized reporting in client preferred format available
