Medical Bill Review

CareWorks USA’s Correctional Medical Bill Review system allows for medical bills to be assessed for accuracy, appropriateness for payment, prevention of duplicate payments, as well as adherence to jurisdictional-specific requirements.

Our system automatically re-prices correctional bills to the lesser of the billed charges, applicable fee schedule (if appropriate), usual and customary reimbursement rate (UCR), Preferred Provider Organization (PPO) network fee or program-specific negotiated rates.

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

Correctional bills can be flagged for utilization review or audit by a nurse, based on clinical criteria or billed charges, when necessary.

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

Customized Program Development

In addition, CareWorks USA can provide consulting services to develop Correctional Health Care Protocols customized to your program’s unique needs.