Health Systems International

Our Services: Bill Review

Payors requiring a broader spectrum of customized medical cost management services utilize HSI's Bill Review service.

HSI currently provides these services to clients in specialized markets such as International Payors, Maritime, Reinsurance, and Worker's Compensation. HSI assists payors in these largely specializedmarkets with customized solutions designed to achieve the lowest possiblecost of care for their covered individuals.

BILL REVIEW: What is it?

HSI Bill Review Solutions are Customized Solutions for our Specialized Markets and include the following service options:

Bill Review Audit

Bill Review Audit includes reviews for appropriateness, integrity and validity such as correct coding, medical necessity, usual and customary charge review, pre-existing condition analysis, coordination of benefits/third party liability and recovery, repatriation considerations, and coordinated review with client's in-house medical review or contracted Medical Case Review.

Repricing

After detailed Bill Review, claims from bill review clients can often access the same networks discount agreements as standard repricing clients to maximize savings. HSI contracts with partner PPOs to provide network access to its specialized clients. Discounts are then applied to an accurate bill to ensure accurate and appropriate payment to the healthcare provider.

Claim Negotiation

HSI's claims negotiation service is strategically designed to discount claims that fall out-of-network, providing clients a complete solution to their cost containment needs. HSI works with both the payor and providers to establish fair reimbursement for out-of-network claims. By investing in expertise, data, and positive provider relationships, the Company is able to earn discounts on 97 - 99% of healthcare claim dollars in total.

Medical Case Review

HSI employs contracted physicians and registered nurses to consult with clients regarding the effectiveness of a covered person's treatment. The Company's network of board-certified physicians and registered nurses provides consultation and support related to implementing cutting edge cost containment and quality management strategies currently being used within the healthcare industry. Medical management services include prospective, concurrent and retrospective review, pre-certification, emergency room review, and utilization management reporting.

Medical Appointments

HSI offers appointment services for cruise line and other maritime clients. The primary function is obtaining the next available appointment within the requested specialty. This service includes capabilities for specialty visits at port, disembarkation services as needed, and full coordination with the ship doctor, patient and provider of medical service.

Payment Processing

HSI offers administration of payments to US and international healthcare providers on behalf of specialized clients to help clients ensure contract and regulatory compliance as well as timely payments. Payment processing includes both check cutting and 1099 issuance resulting in administrative savings for the client.

Customer, Patient, and Provider Assistance

HSI's approach to service includes access to experienced staff as well as the capability to self-serve through HSI's interactive on-line web portal. Customer service staff responds to incoming calls 24 x 7 and assists with claim status inquiries, reporting requests, provider referrals, hotel and transportation arrangements, coordination of air repatriation and/or evacuation, appropriate condition and financial updates (including reserves) to clients, notifications for first contact of illness/injury reporting, and ID card printing.