TL_2.1.18

Workers' Compensation Specialty Bill Review & Resolution

Available from Equian

The process for workers' compensation specialty bill review and resolution includes determining which claims will benefit from negotiation using various tools, including Medicare rates, our proprietary database for implant/supply costs, industry benchmarks, and national payers’ payment schedules. Once we’ve utilized these tools, we’re able to establish a floor for negotiation.

Specialty Bill Review criteria includes:

- In-network bills without a resulting PPO savings
- In-network bills with less than satisfactory savings
- Out of network bill regardless of fee schedule savings
- Bills over $10,000 in billed charges

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