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Cost Containment Initiatives


Utilization Review (UR)

Our Utilization Review specialist will scrutinize how much and how often medical services were used on a file. Utilization of services is carefully monitored for appropriateness and treatment effectiveness. All reviews done by a Certified Professional in Utilization Review.

Cost Projection

Our Cost Projection Report will assist with setting reserves or to adjust previously set reserves. Our specialist will examine current medical costs trended forward and combine with expected additional future costs in one report. Just send the medical file and we will do the rest. We will even consult with our in house physicians at no charge if there is any question as to the reasonably expected course of treatment for your claimant.

Prospective Fee Negotiation for medical goods and services

 

In the case where your file does not meet the criteria for full or task nurse case management we will negotiate the rate for such special needs as non-hospital in-patient stays. In the case of acute, sub-acute and rehab stays, we guarantee we will check at least facilities where available and then negotiate the best possible rate. We will then report our findings and suggest the most appropriate medical facility to meet your claimant's needs at the best possible price. It has been our experience that significant savings can also be found with DME, imaging and home care.

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