Careworks Consultants, Inc. (CCI) has a fifty -year history of successfully partnering with self-insured employers. One of the key services we provide is medical bill review and payment. These services include:
- Medical bill review engine – SmartAdvisor – accessing alternative provider networks.
- Powerful rules engine – Capstone Decision Manager.
- Allows for customization of processes.
- Allows for specialized bill review.
- 100% of all bills identified and indexed within 48 hours.
- Certified coder on staff.
- 90% of all medical fee bills processed within 14 days of receipt.
- Systematic editing based upon NCCI standards identifies:
- Inappropriate billing practices and corrects them;
- Fee schedule requirements; and,
- PPO network reductions.
- All bills are reviewed and processed according to claim allowances, diagnosis allowances, authorizations and jurisdictional guidelines.
- Special bill processing account instructions where desired.
- Medical bill payments over $5,000 are reviewed by the Team Manager and the Fee Bill Manager for appropriate claim allowances and correct payment.
- Hospital bill payments over $7,500 are audited for appropriate billing according to documented services and claim allowances.
- Fee Bill Inquiries.
- Telephonic inquiries returned within 24 hours.
- Written inquiries responded to within 14 days.
- All NCCI editing appeals are reviewed and responded to by an on-staff certified coder.