Medical Bill Review – Workers’ Compensation

Patriot Care Management utilizes a Medical Bill Review program within the workers’ compensation market. The Medical Bill Review program generates both savings and efficiencies for clients. Savings result from reductions on medical bills through the application of the appropriate fee schedule / UCR and utilization review audits.

Patriot Care Management eliminates billing abuse by ensuring that each bill goes through the appropriate review process by offering:

A PPO Network Application

Patriot Care Management has a PPO network that consists of multiple networks instead of a singular network. This delivers maximum savings and penetration for each client based on their jurisdictional requirements. In addition, we continually perform subsequent analysis to ensure that each client’s expectations and needs are exceeded.

  • PPO network discounts are applied via an overnight pend and transmit process, which allows the designated network to apply the most current contracted discounts, consequently increasing accuracy and reducing provider disputes.
  • Our Bill Review program retrospectively reviews pharmacy claims to ensure that network reductions, contracted rates, Fee Schedule/UCR were applied properly. In addition, the program provides out of network reviews and negotiations.
  • We recognize that rising medical costs are a large factor contributing to the escalating cost of medical claims. Patriot Care Management utilizes a pharmacy benefit management program to better assist clients.