"The sum of what has been learned evolves into ideas and skill that has been imparted"

In-house Medical Cost Containment, IME, Legal, Arbitration and SIU staff make these processes effective and efficient.

MEDICAL COST CONTAINMENT

A unit comprised of medical professionals. The function of this unit is as follows:

• Review diagnostic testing for medical necessity and the need for a peer- review.
• Review hospital bills for MVA casual relationship, appropriate DRG charges, unbundling of services.
• Review treatment plans for excessiveness.
• Review and discuss claims with Examiners, Supervisors, SIU and Subro.
• Develop and initiate training classes to educate No-fault and BI Examiners in current trends of medical testing, billing and treatment.
• Prepare cases with Arbitration Unit and supply documentation to support your position.
• Collaborate with the Legal Department to prepare EUOs question and Arbitration defenses; testify as necessary.
• Research information to support denials and Arbitration issues.
• Collaborate with Subrogation Unit to develop defenses for Subro Arbitration and testify as necessary.
• Cost out peer reviews for Examiners.

ARBITRATION

This unit consists of highly experienced Examiners, headed by a Supervisor Specialist.  

INDEPENDENT MEDICAL EXAMS

Here exams are scheduled, the letters to the claimants and attorneys are initiated and sent, and within 48 hours of the exam the outcome is known.   If an examination results in a negative outcome, this unit issues the denial no later than 72 hours after the examination, thus finalizing the medical reimbursement of treatment.

Medicals are reviewed for the appropriateness of the exam requested to ensure the most specific exam is performed.

The cost of our IMEs is minimal and cannot be surpassed.  The product we deliver is comprehensive, professional and has the ability to overcome the arbitration process.

EXAMINATION UNDER OATH

As a result of all our investigative processes, when questions continue to go unanswered, EUOs are utilized.

Our EUO Department is adept in asking claimants, providers, etc. the questions necessary to elicit information upon when claims decisions can be made. Fraud remains an ever present obstacle to the success of our operation.  EUOs are an effective tool in overcoming this danger.