Products & Services: Medical Bill Review
Real Savings.
Salus Medical Bill Review
Advanced technology.
Expert review.
Personal service.
While many TPA’s outsource medical bill review, Salus’ in-house team of experts work hand-in-hand with our claims team and our customers to ensure accurate and appropriate payment for medical services.
Our industry leading bill review software is integrated with our claims system. This comprehensive system:
- ingests and adjudicates medical bills
- prices bills to state mandated fee schedules or usual and customary rates
- ensures that negotiated provider discounts are applied
- detects and eliminates duplicate billings, and
- denies payments for unauthorized services.
Our advanced, customizable rules engine allows straight-through processing of bills or, when appropriate, routes bills for expert review to our senior auditors, who in-turn, refer complex hospital reviews to trained clinicians when appropriate.
Our combination of state-of-the-art systems, hands-on experience, and advanced data analytics enables Salus to adjudicate negotiated rates and eliminate payments for duplicate and unauthorized bills.
Features and benefits
- Medical bill review services for all fee and UCR schedules across jurisdictions nationwide
- The most comprehensive preferred provider network in the country reduces hospital and physician bill costs
- Nearly 30 years of workplace injury expertise
- Complete artifact capture, including mailroom and e-bill intake
- Document imaging for fast, accurate medical bill processing
- Automatic classification by document type
- Validation of OCR and/or keyed data
- Client configurable rules engine enables custom rules and workflows that increase straight-through processing of bills and route exceptions for review
- Software guided review, repricing and compliance by bill review and compliance experts
- Integrated utilization review for increased auto adjudication of bills
- Substantial reductions on medical billing through our analysis of charges and length of stay against several data points, from which an appropriate and fair final bill can be negotiated
- Adjuster Portal increases adjuster productivity with a range of interactive tools that provide real-time visibility and control
- Up-to-date fee schedules, PPO network agreements and regulatory requirements
- Regulatory reporting including full service NCCI Medical Data Call Reporting and Medical EDI State Reporting
- Ad-hoc reporting tools to easily develop and deploy custom reports
At a glance
|
SAVINGS |
||
| 60% | Average, defensible net savings | |
|
|
||
|
RETURN ON INVESTMENT |
||
| 1,880% | For every dollar spent on bill review | |
|
|
||
|
TURN-AROUND TIME |
||
| < 3 days | Faster than state mandates 98% of time | |
|
|
||
|
DISPUTES |
||
| < 2% | results questioned by originating provider | |
