Medical Bill Repricing

Medical Bill Repricing

Sierra Nevada Administrators uses leading bill review software solutions for medical bill review and repricing. This powerful tool reviews medical bills based on the rules, regulations and guidelines set by the state workers' compensation fee schedule and thus ensures optimal savings through application of these rules.

The bill review system is integrated to include all elements of medical cost containment, including review of bills to regulatory fee schedules, PPO contract discounts, fee negotiations, incorporation of medical management recommendations, claims system integration and automated management reporting.

Our system features an automated workers' compensation bill adjudication system with built in audit rules to identify duplicate billings, over utilization, bundling and unbundling, and up-coding. To monitor utilization, we have a prior authorization process that incorporates standardized workers' compensation treatment protocols to identify whether treatment is appropriate.