To become the market leader in the medical cost containment field by offering the first fully integrated bill review, utilization review and claims management software suite. We will deliver superior results to our clients and stakeholders while maximizing shareholder value.
We are committed to achieving the maximum savings by employing the integration of UR and bill review through our proprietary software, combined with our highly experienced staff. The underpinnings of the solutions outlined above relate to a corporate commitment to excellence in service and client satisfaction. We believe in conducting regularly scheduled stewardship meetings with our clients. In those meetings, program performance is reviewed, including the review of subcontracted relationships.
The most common frustration payers have today is the inefficient integration in the bill review/UR Process. While many bill review vendors claim integration with UR, the nature of that integration is problematic because the UR process is primarily notes driven, while bill review is primarily data driven.
We have found the following to add further complexity to the process:
- • UR Staff usually does not have visibility to what the provider will actually bill for the approved services. The provider can be instructed to bill under certain codes, but there is no way of knowing if the provider will actually comply.
- • Bill Reviewers are under pressure to maintain production standards (For example 150 bills per day), and do not always have the time or are inclined to take the time necessary to read UR notes.
The ManageWare solution employs the use of code ranges generated out of the UR module to create "Code Restriction Rules" that are presented to the bill review staff in an automated way. The system is able to apply the rule to a range of procedure codes that relate to the type of service selected when the UR decision is rendered.
For example, a chiropractic request contains four procedure codes that are related to that type of service. If a Chiropractor requests 12 visits and only six are approved, the system would create a rule to deny any Chiropractic procedures in excess of the approved amount, regardless of the Chiropractic code billed. This allows the bill reviewers to react to a rule that instructs them to review, override or accept the recommendation presented to them in a way that does not interrupt their processing production.
Overall Solution Design
ManageWare provides complete workflow analysis and system interface review services for each client to ensure a successful implementation from both a workflow and technology perspective.
Claims/Bill Review System Integration
The ManageWare technology staff is highly skilled and experienced in systems integration providing the client with a technology team that will minimize integration impact on existing IT resources. ManageWare has established connectivity with several of the major claims system vendors.