Careworks Consultants, Inc. has a 60-year history of successfully partnering with self-insured employers. One of the key services we provide is medical bill review and payment. We have saved our clients more than $140 million.

These services include:

Industry-Leading Software

With our medical, bill-review engine, SmartAdvisor, you will have access to alternative provider networks, along with the highest cost-savings possible. Capstone Decision Manager, our powerful rules engine, allows CareWorks Consultants to customize your billing and review process to ensure the most cost-effective processing available.

CareWorks Consultants Certified Coders

We strive to exceed your expectations. CareWorks Consultants has the capability to provide you with a certified coder who reviews and responds to all NCCI editing appeals. Using editing that’s based on NCCI standards, we identify inappropriate billing practices, fee schedule requirements and PPO network reductions, thereby saving you the most money possible for quality medical care.

Thorough, Accurate Billing Reviews

All bills are processed according to claim allowances, diagnosis allowances, authorizations and jurisdictional guidelines. Our Claims Team Managers and Fee Bill Managers review medical bill payments over $5,000 for appropriate claims allowances and correct payment.

We audit hospital bill payments—reduced by the state fee schedule but still more than $7,500—to make sure all costs are appropriate in relation to documented services and claim allowances.

1099 Reporting/Tracking