We created our family of solutions by listening to our customers and solving their problems.

 

Direct negotiations (DN)

Built for Third Party Liability, non-attorney represented claims. Simplifies the claims process for both claimant and provider by securing consensual discounts on medical specials directly from the providers. DN is the only solution capable of retrieving, discounting and paying the provider directly for the bill. We differentiate this solution by providing industry best turn times with exceptional national results.

Live Benchmarks (LB)

Built for Third Party Liability, attorney represented claims. Reduces the high dollar and complex facility bills in demand packages that can be obstacles to a fair and reasonable settlement. Provides adjuster with a written, accepted reimbursement amount from the facility rather than a “reference price” benchmark which may deteriorate during negotiation. Eliminates much of the negotiation leakage that drives bodily injury severity, and compliments other cost containment solutions addressing professional bills.

Claims Validation (CV)

Built for Third Party Liability, attorney represented claims. Validates the medical bill charges submitted in a demand package. Provides a high value return to adjusters by insuring payment accuracy through a quick audit of all bills for fraud and collateral source payments.

Demand Package review (DPR)

Full demand review suite for Third Party Liability, attorney represented claims. Each component part can be ordered independently. Outputs customized to carrier preference.

  • Sorting and Indexing: Organizes the demand and includes hyperlinks to medical bills. Sorts medical records by provider specialty and dates of service. Highlights gaps in treatment/excessive treatments by specialty. Enhanced Keyword Search helps identify questionable causality, degenerative or pre-existing conditions.

  • Bill Review: Evolved approach specific to Third Party Liability to include multiple reference points per bill where applicable. Easy, actionable talking points for adjusters.

  • Legal Nurse Review: Three tier solution depending on demand size or adjuster need. Summary of pertinent details of the medicals, analysis and defense points. Full, detailed overview of events include pre and past medical information, as well as pre-DOL, demographics.

Prospective care (pc)

Secures a fair and reasonable price for medical services before they are rendered. Solution targets high priority services like Surgery, Acute Rehab (Burns, Brain, Spine Injury), Post Acute Care, Long Term Care, and Home Health Care.

  • Workers Compensation (WC): Traditionally applied to non-fee scheduled services, but can be used in states like Massachusetts to negotiate above fee schedule surgeries, or in out of state scenarios to secure the more favorable fee schedule.

  • First Party Auto (1P): Specifically targeting Michigan PIP to secure favorable rates prior to services being rendered.

Complex negotiations (CN)

Reduces high dollar medical bills from complex claims and unique insurance lines. We are committed to outperform where it counts.

  • Workers Compensation (WC): Negotiate catastrophic injuries, out of state care, U&C alternatives, and other high dollar losses like air ambulance.

  • Occupations Accident (OCAC): A unique approach to Occupational Accident cost containment. Led by fee schedule backed negotiations (50-90% discounts) and backed up by networks, U&C pricing and more.

  • First Party Auto (1P): Puts smart cost containment tools back into the adjuster’s hands in an industry where automation is failing to address complexity. We customize our criteria to each payer to maximize program results while balancing adjuster efficiency goals.