Medical Bill Review

Tailored based on the unique needs of managing workers compensation injuries and recoveries, we use our proprietary bill-review software, CASE-e. Collecting all data in a single robust repository, we create a centralized data set to give us deeper insights into the wellbeing of injured workers and the trajectories of their journeys to better health.

With data collected, our CPC-certified code-review specialists as well as dedicated nurses review any appropriately flagged events. From there, we offer usual-and-customary review.

Our Medical Bill Review service includes unique components and methodologies, creating an integrated process focused on value and continuity.

• Fee Schedule and Usual, Customary, and Reasonable (UCR) Repricing: We leverage strong relationships with multiple vendors to perform high-volume fee schedule and UCR repricing efficiently.
• Body Part Mapping: A proprietary system created by BMMS that automatically matches body parts referenced in the claim to the specific procedure code, facilitating billing accuracy and relevance.
• Nurse / Code Audit Review: We combine Retrospective Nurse Review and Code Review to provide comprehensive clinical validation and audit findings on submitted bills.
• Out-of-Network Repricing: We apply proprietary out-of-network repricing methodologies to achieve the best possible cost reductions for bills submitted outside of established networks.
• Bill Review Negotiation: We actively pursue bill review negotiations, primarily on out-of-network bills, to achieve additional cost savings.
• Berkley Care Network: We manage the Berkley Care Network, directing injured workers to quality providers and leveraging network agreements to control costs.