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.