Medical bill review
Provider bills checked against the fee schedule
How a run goes
The steps this agent takes, in order, and what each one leaves behind.
Reads the bill, the claim and the fee schedule
Checks each provider bill against the fee schedule, the treatment authorized on the claim and the duplicate billing rules
Applies the rules and computes the allowed amount
Drafts the explanation of review with the reductions and the reason codes
Drafts the explanation and the monthly report
Reports savings by reduction type and the providers billing outside the schedule
Works in
Box, Snowflake, ServiceNow
Box, Snowflake, ServiceNowWhat it does
- Checks each provider bill against the fee schedule, the treatment authorized on the claim and the duplicate billing rules
- Drafts the explanation of review with the reductions and the reason codes
- Reports savings by reduction type and the providers billing outside the schedule
Connects to
Need it to work differently?
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