Third Party Administration

Bill Review & Re-pricing

Auditing Bills Helps Identify Savings, Reduce Fraud, and Ultimately, Saves Our Customers Money

We combine technology and individual review to identify unusual or incorrect billing procedures such as up-coding or unbundling of certain key services. The medical bill review program discovers savings, helps reduce fraud, identifies duplicate and unnecessary charges, and helps ensure accurate payment.

Our bill review system helps customers save even more because we:

  • re-price bills so that they are generally less than the state-mandated fee schedule;
  • help eliminate unnecessary charges, such as overlapped billing or unrelated fees;
  • audit the billing process to ensure providers don’t bill your injured employees;
  • communicate directly with providers to help avoid problems with bills or claims.

We do all medical bill review in-house. We also have access to specialized software that has been integrated into our bill adjudication programming, ensuring that bills are paid correctly. This software, utilized by most national commercial health insurers, distinguishes us from our competitors.

In addition to discounts, our bill review process checks for inappropriate billing practices including: bundling/unbundling, global fees, units, age/gender edits, as well as downcoding/upcoding. It also insures that CPT codes submitted are appropriate for the ICD-9 diagnosis.

All out of network and paper bills are checked against previously rejected transactions to eliminate duplication. The bill review team will then re-price any bills at network pharmacies at the contracted rate, including those submitted by a third party biller.

Want to know more about AmeriHealth Casualty? Call 1-800-297-2726.