Identifying potential cost savings quickly and efficiently.

All out-of-network bills are audited through an industry-leading medical bill review system. In addition to fee guideline application, we apply thousands of clinical edits and out-of-network bill audit functions  to out-of-network bills that maximize savings for our clients.

Identifying potential cost savings quickly and efficiently.

Maximizing savings with clinical edits that uncover:

  • Multiple surgical procedure rules
  • Bundling codes that should be identified singly, but are billed separately by the provider
  • Aftercare days following surgery (follow-up time included in the cost of surgery)
  • Multiple visits or surgeries on the same day
  • Conflicting codes on the same day
  • Physical therapy code combinations
  • CPT – Diagnosis of code conflicts
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