Workers' Compensation
Managed Care Services
We help achieve the highest level of medical savings and payment integrity through innovative cost containment solutions.
We’ll partner with you to
- Exceed your savings goals with proprietary technology and exceptional professional support
- Strengthen your review results with state- and industry-specific expertise
- Maximize care access and in-network utilization with leading network strategies
- Support your program stakeholders with experienced customer service resources
Our managed care program
Comprehensive medical bill review
- eBill or paper bill intake
- Mailroom processing
- Fee schedule/UCR application
- Expert rules, audit, and negotiations
- PPO networks
- Customized auto-adjudication
- Utilization management
- Customized EDI and reporting
- Customer support line
Expert rules, audit, and negotiations
- Unique platform-independent solution
- Dynamic Clinical & Coding Logic (CCL) rules
- Dynamic TrueCourse (Wisconsin-specific) bill review
- Clinical and coding expertise
- Out-of-network negotiations
- Customized reporting
- Compliance, regulatory, and state-specific expertise
PPO network offering
- National coverage for maximized access
- Customizable network to meet client-specific needs
- Simplified administration
- Ongoing data validation
- Provider panels and lookup tools
- Dedicated customer service team
Clearinghouse and payment services
- Fast, accurate, secure web-based eBilling
- Online, standardized communication
- Paper-to-electronic conversion
- Web-based document management
- Highly configurable payment platform
- Extensive ePayment networks
- Mutiple, layered fraud detection
