"A quality that confers superiority"
It is mandatory that all claims functions comply with the prescribed regulatory guidelines. Compliance is essential from both a regulatory and business perspective. Programs in place have enabled us to meet and exceed the 90% compliance requirement.
In an effort to meet compliance, we also utilize systems in various capacities. These range from mail tracking, to document storage, and retrieval to medical bill processing. In utilizing systems, the goal is improved productivity, reduce losses, reduced expense costs, improved reporting capabilities, better customer service and in general, a simplified claim process.
Claims System Medical Bill Re-pricing (CSBR)
CSBR is a highly automated user-driven health claim processing system. CSBR allows for the most comprehensive adjudication of claims available.
We have adapted CSBR to meet the needs of your No-fault Department.
The Claim Prep unit has been trained on the Workers Comp Fee Schedule. Here bills are revised and codes are overridden as necessary to the most appropriate code for the service provided. This created a more efficient workflow.