Customized bill handling to meet your needs.

At CareWorks USA, we can conduct a thorough review to ensure that reimbursement coincides with the medical necessity determination. We’ll use clinical editing, bundling/unbundling and/or appropriate coding to ensure accurate re-pricing. All bills are reduced to fee schedule or UCR (based on jurisdiction) prior to PPO reductions being applied. Following re-pricing, CareWorks USA can process checks for provider reimbursement with an accompanying detailed Explanation of Review (EOR), if desired. We process bills promptly in order to ensure that we meet all mandated deadlines. A full menu of bill review reports is available with customization options provided at no additional expense.

Medical Bill Audits

Ensuring that charges are related to allowed conditions and within medical necessity guidelines.

• A nurse reviews bills to reflect maximum savings while still observing any jurisdictional requirements that may exist.
• Bills are reviewed line-by-line to determine the relationship of billed amounts to documented procedures and relevance to the allowed claim.
• We ensure that the employer only pays for services medically related to the claim and allowed conditions.
• The cost for hospital bill audits is only a percentage of the realized savings; therefore the employer reaps the majority of cost savings.
• Our nurses can defend audit recommendations if questioned by a provider.