Services: Bill Review / Audit

PIP Fee Scheduling and Bill Review Services 

Active Care Auto provides medical bill review services using a web-based system integrated with our utilization management database. This integration assures proper bill re-pricing based on pre-certification history. By utilizing Active Care Auto’s pre-contracted and negotiated auto specific medical provider network, we are able to achieve savings nearly 15 % below the PIP FEE Schedule.

Medical Bill Review Includes:
 
  • Application of State Fee Schedules or Usual & Customary Fees
  • Application of PPO Network
  • Anesthesia and Surgical Review
  • CPT Code Review
  • Application of NCCI edits when appropriate
  • Duplicate submission check
  • Generation of EOR
  • Validation of Pre-Certification requirements
  • Response to provider inquiries
  • Diagnosis code review for causality
  • Support for arbitration and litigation
  • Electronic data submission and sending
  • Negotiation services when no fee schedule/UCR applicable
  • Nurse Review of appropriateness of services


 

 

 

 

 

 

 

 

 

 

 

Request a Bill Review or Bill Audit


Bill Negotiations

In order to realize maximum savings, Active Care Auto has developed a non-network negotiation program to work in conjunction with our network savings. Non-network bills are channeled to the negotiation team for efficient and effective processing, providing a total management solution.


Bill Audit Services

Active Care Auto provides onsite and desk audit services performed by our staff of experienced Registered Nurses. Our audit specialists ensure appropriateness of provider billing practices assuring that bills are repriced in accordance with the Usual and Customary or PIP Fee Schedules.

The Active Care Auto Bill Review Advantage

If PPO access option is chosen by our customer, the provider contracts stipulate that all disputes must go through Active Care’s Internal Dispute Resolution System for settlement

  • Web-based voluntary provider network tool lookup
  • Automated bill review
  • Our system can accommodate electronic billing
  • Identification of unrelated medical conditions/pre-existing conditions
  • Negotiation of prompt pay discount
  • ICD-9/CPT code review


 

 

 

 

 

Request a Bill Review or Bill Audit

 
 
  Active Care Auto corporate office: 2740 Route 10, Suite 304, Morris Plains, NJ 07950 phone: (800)752-5158 fax: (973)257-2287