Specialty Bill Review

Experts review specialty medical bills, such as hospital, outpatient facility, pharmacy, durable medical equipment, radiology, physician and/or physical medicine bills. All bills will be reviewed to the Official Medical Fee Schedule for workers’ compensation and/or other usual and customary data, if applicable. Defense of these reviews may include negotiation as well as representation at lien conference or trial.

Cost Projections

Cost Projections provide a snapshot of all medical expenses involved in particular surgery and/or treatment plan.  All values are calculated based on the various fee schedules for Workers’ Compensation.  To complete a cost projection, medical providers will request for an authority form, available medical reports, or detailed information on the proposed treatment (i.e. hospital name, surgery/treatment type). Cost projections are of value to claims examiners who have to reserve their claim file for future medical expenses.  It can also be used by defense counsel for projecting value for settlements.  

Medical Case Management (Including Spanish Speaking Case Managers)

Experienced case managers throughout California support the employee’s expeditious recovery from injury and the medical cost containment of insurance claims. We offer responsive service and function as a valuable resource for the employer, the claims staff, the injured employee and the medical community with focus on the employee’s timely return to work. Spanish speaking case managers further assist our customers by guiding cases involving Spanish speaking employees to better outcomes via direct communication with the employee and the employee’s family.

Medical Record Review (Workers’ Compensation and Liability)

Experienced case managers review medical records producing a chronology and/or summary of the records.  Upon request, the case managers will draft questions for an upcoming physician appointment with a specialist or to determine AOE/COE.

Lien Resolution Services / Conference and Trial Appearances Specialty Bill Review

Expert bill reviewers support a favorable outcome in defense against outstanding medical liens. These experts determine the actual value of the submitted medical bills based on the workers’ compensation fee schedule  or other usual and customary data, if applicable. They consider all available factors in determining the reasonable value of the outstanding lien prior to negotiating settlement. When appearing as your bill review expert witness at lien conference or trial, these experts can review all bills prior to the appearance, prepare exhibits in preparation for trial, review any last minute bills submitted at conference or trial while in attendance, assist defense council with settlement and testify as needed.