
Medical Bill Review
Prime Health Services offers an innovative approach to our Bill
Review Program that delivers clients maximum savings on their
medical claims. Our technology continues to be at the forefront of
the industry which allows our clients to achieve results beyond
industry expectations.

Renovo, our
proprietary bill review software, offers Prime Health's clients an
application that is integrated with PPO Networks along with coding
reviews, duplicate detection, and industry specific adjustments.
This seamless program gives our clients rapid turnaround time,
online access, customized features and reporting, and competitive
pricing options.
Corrections: Renovo offers the
corrections industry real-time repricing for off-site medical
claims. Our state of the art software is equipped to adjudicate
medical claims according to the Center for Medicare and Medicaid
(CMS) standards to assure that only appropriate claim charges on
bills are reimbursed. This service takes advantage of a state of
the art, fully integrated electronic claims processing system.
Individual edits are performed at the detail claim line level and
include industry-standard edits such as:
- Unauthorized/ inappropriate services
- Incomplete claims
- Duplicate claims
- Invalid or excessive codes
- Unbundled charges
Renovo has the ability to fully integrate our nationwide PPO
Network to apply reductions on contracted providers. This system
allows you to quickly process your bills and streamline the process
which eliminates costly errors and increases administrative
efficiency.
Group Health: Renovo offers the Group
Health industry a repricing software program that allows you to
integrate PPO Networks along with the ability to find and correct
inaccurate, excessive and inappropriate charges. Renovo's data
integrity is key to accuracy in repricing Group Health bills.
Generate easy to read Explanation of Benefits (EOB) along with
customized reporting will meet our clients' needs for their Managed
Care Program.
Workers' Compensation and Auto
Liability: Prime Health's knowledge coupled with
Renovo enables our Coders to ensure accurate payment is made on all
claims, all types and sizes. Renovo successfully saves the maximum
dollar amount without jeopardizing the patient's care. Key
functions of Renovo for the Workers' Compensation industry are:
- Automation of the most up to date fee schedule and state law
adjustments
- Usual and customary review
- Unbundling and code review/edits
- Identifying bill duplication
- Fraud detection
- QA assessments on every bill
- Real-Time application of PPO Reductions
- Prompt turn-around
- Straightforward EOR
- State reporting
- HIPAA compliant data transactions
- Customized utilization reporting
Renovo's features combined with Prime Health's skilled staff
contribute to our commitment to quality assurance and allow our
clients to have the confidence in their Managed Care Program. With
Prime Health staying at the cutting edge of technology through our
EDI interfaces using Cloud Technology, our bill review program
continues to develop more efficient processes to allow each
department to work simultaneously.
Our Bill Review offers customized programs that fit each
individual client's needs. Bill review services can be performed
nationwide.
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