Bill Review
The Health Systems International Bill Review Solution includes a line-by-line review of a medical bill. Items that are reviewed include, but are not limited to: medical necessity, appropriateness, coordination of benefits, integrity, validity, and pre-existing conditions. Expert reviewers directly communicate with providers to remove charges identified in a review. Bill Review services are completed on Health Systems International network provider bills as well as non-network provider bills.
Bill Negotiation
The Health Systems International Bill Negotiation Solution is strategically designed for international clients to discount bills that were not coordinated in advance through an Health Systems International contracted provider. Bills are discounted through expert negotiators and direct provider communication. We receive signed agreements for all negotiations.
Bill Audit
Our Bill Audit Solution is an expanded version of the Bill Review Solution. Auditing is a highly specialized bill examination and audit of medical records and supporting documentation for medical services. Health Systems International audit staff includes experienced nurses and certified coders to maximize the savings for our international clients.
PPO Access/Repricing
Our PPO Access/Repricing Solution provides single-source access for our international clients to the market’s largest selection of PPO networks, including U.S. national, regional, workers’ compensation, and specialty networks. For our international clients, we focus our efforts on continually expanding access in critical travel and student service areas.
Care Management
Our International Payer Case Management Solution includes many different services revolving around a lower net cost of care that focuses on case management. Case Management services include on-site and telephonic nursing services. We also deliver catastrophic case management and crisis intervention.
Pharmacy
Our Pharmacy Solution is a specialized pharmacy management program for our international clients. We can provide a customized plan to control prescription utilization and lower the cost of pharmaceuticals. Strategies to reduce pharmacy costs include: cost-based rates at over 62,000 pharmacies throughout the U.S., Drug Utilization Review, generic substitution and therapeutic equivalent strategies, customized restrictions, authorizations, formularies, and mail-order programs.
Durable Medical Equipment
Our Durable Medical Equipment (DME) Solution delivers nationwide DME and services that ensure members receive quality equipment in a home setting while recovering from illness or injury, as well as access to knowledgeable equipment specialists. Our range of quality products is available through board-certified professionals who are highly trained to service multiple specialty needs and to evaluate and manage the implementation of the equipment. Examples of the equipment offered include, but are not limited to: home health products; beds and accessories; wheelchairs and accessories; bath safety and aides; DME electromedical devices; bracing, orthotics and prosthetics; respiratory therapy; medical supplies; and services such as equipment evaluations, rentals, sales and service repairs, and home and vehicle modifications.Business Intelligence Portal
Our Business Intelligence Portal is an easy-to-use, browser-based application that enables our international clients to access key performance data on demand. Clients can quickly see where their company stands on indicators that are most important to their business.
Clients can access information from databases anywhere in the company so that data can be analyzed and shared in real time. Our Business Intelligence Portal makes it simple to establish medical goals, assess savings performance, and share data with clients, members, or employees instantly. Clients are then able to make decisions faster and minimize resources for reporting—all while lowering costs.