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| CUT COSTS WITH INTERCARE BILL REVIEW |
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InterMed’s Bill Review Services is a computer assisted audit service that saves payers time and money by providing claims administrators with a quick and reliable method of verifying the accuracy of provider charges and their conformity to state mandated fee schedules or usual and customary charges for a given geographic area. Through our extensive physician and hospital PPO networks, substantial saving beyond fee schedules can be achieved. Intercare’s bill review and PPO savings in California have developed average savings of 54% below billed charges. |
| Second Level Review |
Intercare’s Second Level Review Program is a complement to our standard bill review process. Based on specific dollar and/or PPO thresholds a bill will be identified as a candidate for the program and sent to a senior bill review specialist for off line handling and negotiation. A majority of these bills are for inpatient services, outpatient surgery centers and large DME billings that do not result in a significant fee schedule or PPO discount. The senior bill review specialist will initiate calls to the provider in an attempt to negotiate a retrospective discount on the bill in question. Once negotiated the bill is returned to the automated workers’ compensation queue and an Explanation of Review is created reflecting the negotiated rate and subsequent savings. Because of the special handling process of this program our usual turn around is between 7-10days on these particular bills |
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| Prescription Drug Management |
Because prescriptions are one of the fastest rising costs associated with medical treatment, Intercare developed this innovative program in-house to provide effective cost controls for this expensive aspect of a workers’ compensation claim. The PharmacyCompTM program is in place to streamline the workers’ compensation claims process by providing a fast and satisfactory experience at the pharmacy. It is specifically designed to benefit patients and pharmacies by simplifying the prescription fulfillment and billing process for all involved. |
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| Networks |
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Medical Provider Network |
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Intercare will work with our clients to develop a boutique Medical Provider Network (MPN), which complies with the regulatory mandates, to provide continuity of care for the entire employee population. We will work hand-in-hand with our clients to complete the application process and ensure that the MPN created includes only those physicians who know and understand the workers compensation process. In addition, our network providers are subject to strict ACOEM guideline controls, and are evaluated for their favorable performance generation outcomes, business ethics, and customer satisfaction.
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PPO |
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With lost time and permanent disability being two of the biggest cost drivers in workers' compensation, the most cost effective approach is to identify treatment plans that speed a patient’s recovery time and result in the appropriate level of permanent disability, if any. Our system aligns the incentives of the employer, employee and physician, resulting in superior outcomes—and has been designed to be extremely user friendly for all parties involved. The workers’ compensation system is in place to protect the injured employee. Each employer can maintain medical control by annually assessing all network providers’ outcomes and performance. |
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Physical Therapy Network |
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InterMed’s physical medicine network encompasses over 20,000 locations, 45,000 providers and nationwide coverage in 51 jurisdictions. National savings average between 25-40% and an average reduction in utilization by 20-30%. Success of the network comes from aggressive monitoring of the treatment plan, utilization, appropriateness of care and an injured worker’s release to work levels of function. |
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