Bill Review
Premier Prizm Solutions' proprietary Spectrum technology uses a rule-based software system that assists in the review of provider bills. Spectrum recommends reimbursement according to each state's unique fee schedule, Usual/Customary and Reasonable Fees and if appropriate, PPO. Spectrum is integrated with a utilization management database to assure that bills are repriced with knowledge of each bill's history (if appropriate). Client bill review questions can be directly answered by PPS's call center versus going directly to the adjuster, reducing call volume and increasing adjuster efficiency. This service is offered complimentary to our clients.
Key Features of our Bill Review solution:
- The system can be configured to adjudicate against client specific rules
- Explanation of Benefits are generated and forwarded to the insurance adjuster in a Paperless and Real-Time environment
- Trained staff responds in a timely manner to adjuster's questions and concerns through a two-way notes system
- Standard and Ad-Hoc Reporting - all claim information & data, including vendor information, CPT codes, etc… are available to the client real-time through our reporting platform
- PIP Ledger – automatically keeps track of indemnity dollars spent, while calculating deductibles and co-pays
