Bill Review. In order to assure the most accurate billing and thus alleviate any delays in payment which may result in your organization incurring unnecessary finance charges, the Group will be expected to: Request and Review its bill on a daily basis Request, review and sign all Banquet Event Orders prior to the event. Request, review and sign all event Banquet checks at the conclusion of the event. Request and review final bill prior to check-out.
Bill Review. If available, provide pricing options for bill review services, including flat rate by bill, flat-rate by line-item, and any additional pricing options.
Bill Review. Provider agrees to cooperate with any requests by IHN CCO, or its agent, to review any bills submitted by Provider to determine whether a bill submitted for services rendered to a Member is a Covered Service under the Member’s Health Benefit Plan, subject to this Agreement, properly billed to the services provided (as reflected in the medical record), and that payments made to the Provider were accurate, in accordance with the terms and conditions set forth herein.
Bill Review a. The MCO shall load all County bill review and payment history data available from the prior MCO for the last ten (10) years, regardless of the amount of data at no charge to the County or its TPA.
b. The MCO shall perform the programming requirements, at no charge to the County or TPA, for the interface between the MCO and the TPA’s claims management system. Data interfacing and other system tests shall be completed successfully no less than thirty (30) days prior to program “Go Live” date at no charge to the County. Except as provided in Attachment B, II, A.
c. The MCO shall integrate utilization review determinations into bill review software, at no additional charge, so that bills are accepted for review and payments recommended for authorized or “Certified” medical treatment only.
d. The MCO shall review and process 90% of all properly coded medical bills within five (5) business days of receipt of the bill and agree to comply with all California Workers’ Compensation bill review statutes and regulations. The MCO shall reimburse the County for penalties incurred resulting from the MCO’s negligence or willful action or inaction to comply with all California Workers’ Compensation bill review statutes and regulations.
e. The MCO shall accurately reduce medical provider charges to the California Official Medical Fee Schedule (OMFS). OMFS savings shall be categorized separately from all other types of savings recorded in the bill review software.
f. The MCO shall apply all pre-negotiated medical reimbursement rates under PPO, MPN and Specialty Network provider contracts, as well as with direct medical organizations, physicians, or facilities under “Client Contracted Rates” or “Single Case Agreements”. Additionally, the MCO shall apply other review methods such as nurse desk audits, specialty reviews and Direct Negotiations when applicable.
g. The MCO shall manually review all complex surgical bills for unbundling and upcoding, and with adjuster approval shall enter medical bill negotiations with providers.
h. The MCO shall review in-network and out-of-network bills related to catastrophic claims and/or Complex injuries as determined by the County (i.e. traumatic brain, major burn, spinal cord, multiple trauma, and post-acute injuries). The MCO shall obtain the highest reductions possible through Direct Negotiations with the provider utilizing a senior-level bill review expert, evidenced-based guidelines, and benchmarked data of like and kind rates for si...
