Medical Bill Review
Every medical bill repriced, checked and explained, and paid well inside the 45-day state clock.
Why it matters
Bills arrive as paper and EDI in many formats; reviewers reprice line by line against fee schedules and authorisations while state payment clocks and penalties run.
How the solution handles it
Five agents read each bill, reprice every line to the fee schedule or network rate, check codes and duplicates, match it to approved treatment and draft the explanation of review. A bill review specialist approves the payment.
How a bill moves
Five specialist agents read, reprice, check and match every bill and draft the explanation; a bill review specialist approves payment.
What it reads, and what it hands back.
What goes in
- CMS-1500 and UB-04 bills
- Medical reports
- State fee schedule
- Treatment authorisations
- Network contracts
What comes out
- Repriced bill with reasons
- Explanation of review
- Duplicate and coding flags
- Payment clock
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
Sources: Cal. Labor Code §4603.2 (45 days, then +15% and interest) · NCCI: medical ≈ 53% of losses · “Target” = design goal, measured in the live solution · “typical” = published figures · “estimated” = our estimate
5 specialist agents. One person decides.
More in this division.
Every injury report becomes a coded claim the same day, with the state filing clock in view.
Compensability ReviewA cited compensability file in days, well inside the state’s window to accept or deny.
Medical SummaryThousands of medical pages become a cited chronology and summary before the IME or hearing.
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