State Fee Schedule Adjudication (Including applicable rules and regulations)
Bill review is not a commodity. Bill review software alone cannot properly adjudicate your billed charges, even with a “robust” application. Bill review requires a combination of sophisticated software and seasoned analysts that understand the rules and regulations that govern how a CPT code is applied. Our software incorporates an extensive set of automated rules for each state; when complex, unusual hospital and by report charges are entered, these bills are pended for Specialty Bill Review (SBR). Our analysts average over 12 years of bill review experience and are trained to identify areas prone to incorrect and abusive billing.
Level Service Review
The 80/20 rule applies to your medical charges. Our “Pended” bill status allows our seasoned analysts to triage certain bills to criteria developed over 12 years of actual experience. There are thousands of CPT codes and a small percentage of these codes affect the majority of your medical costs. The codes/bills are categorized according to specialty and reviewed by in-house analysts or to a contracted expert with deeper expertise. The combination of human skill and automated rules “red flag” unbundled and duplicate (full, partial) charges, as well as non-network and other charge types. In this way, we conduct a thorough, detailed review process that ensures proper, defensible and best net value to our clients. Our results have been “certified” by outside consultants that measure and quantify workers’ cost containment companies. Definiti has entered into “performance guarantees” with certain clients and has met and exceeded our benchmarks.
This approach provides consistent, accurate and comprehensive edits to your charges for savings usually missed by a “robust” computer application or data entry personnel.
"The very first, initial impression of any company, is seen in their management staff. Management sets the values and standards upon which their company is founded, and the services provided.
Definiti ranked very high in this regard and has met and exceeded our expectations in providing consistent quality work with no "drop off" over time. The efforts of their staff to bring the best savings to our company, the timeliness of their return on bill reviews, the availability when questions arise, the willingness to go the extra mile....we have never been disappointed. Bashas is pleased to recommend Definiti to anyone."