Services designed to provide quality, cost-effective care.

CareWorks USA’s medical bill review systems assess bills for accuracy and duplication, as well as jurisdictional specific requirements.

Our system automatically re-prices bills to the lesser of the billed charges, state fee schedule, usual and customary reimbursement (UCR) or Preferred Provider Organization (PPO) network negotiated fee.

Multiple system edits detect inappropriate billing practices such as unbundling, upcoding and duplicate procedures. Checks for relatedness of billed procedures, diagnoses and prior authorization are also performed.

Bills can be flagged for utilization review or audit by a nurse, based on clinical criteria or billed charges.

Medical bills are processed within state required timelines. CareWorks USA can provide check-cutting services in addition to review and re-pricing of all medical bills.