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.
"Whenever you enter a relationship with a supplier you wonder about whether or not they can be trusted to do what they say they will do. Will they be available when I have questions? Will the level of service fall off after a period of time? Will the quality of work deteriorate? Definiti has never disappointed me in any of these areas. They are serious about their mantra of keeping clients for life. During the entire time span of my relationship they have met or exceeded my expectations. When I have an issue or question they are prompt with a response and not only to us but to our provider as well.
Definiti has excellent turn-around time. They respond to problems within 24 hours. The quality of service has been consistent and constant with no drop-off. To summarize I would say that the people at Definiti have the highest of integrity simply because they follow-up, follow-through and most importantly they do what they say. I would gladly recommend Definiti for your medical bill review needs."