Our SBR process is a unique program that assures a “fair and reasonable” review as opposed to a “usual & customary” review. Databases automatically increase each year as the costs of healthcare increases. Each year these artificial increases in certain databases are then used for a “usual & customary” reference. Our analyst’s use several nationwide databases that assure this artificial increase are not factored into our review for fair value pricing. {Fair Value Pricing}
Complex File Review
Legal and complex file reviews identify adverse decisions or non workers’ compensation treatment. Our team of registered nurses and contracted physicians provide expert decision support to your charges. Our pended process assures identification of these incorrect or egregious errors.
Out of Network Negotiation Services
Definiti’s dedicated experts have multiple years of experience in fair and reasonable assessments. In our industry, negotiation is just negotiation and usually means a negotiation of charges that is arbitrary or for prompt payment. We take this process a further to research a fair and reasonable charge from several databases to arrive a reasonable allowance and justified by local provider charges. This is not an arbitrary comparison, more like a specialty to specialty or “like” comparison.
Inpatient and Outpatient Line Audit
When the charges from a hospital seem unusually unfair or some items have triggered certain criteria, a line audit of fees may be the best process to identify potential errors and duplicate billing. Our Registered Nurses and expert contractors are trained to audit and identify these errors and recognize inappropriate billing. When inappropriate charges are identified, we may recommend a review by our contracted physician reviewers.
Provider Inquiry Support
A provider needs to hear the reason and method of reduction. They also need to be educated in worker’s compensation billing and the peculiarities of workers’ compensation. Our provider inquiry specialists understand this and are here to assist the provider community in work comp billing. IF we need to say no further additional recommendations are forthcoming, we say it professionally and gracefully.
