Bill Review

Our 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. The Bill Review Solution also includes all 50 states’ rule and fee schedules, U&C fee schedules, and our proprietary PPO Network Matrix solution.

Bill Negotiation

Our Bill Negotiation Solution is strategically designed to further discount bills that are identified by bill review staff and our clients. For example, if a bill has a low fee-schedule reduction or falls outside of a PPO arrangement, Health Systems International expert negotiators attempt to increase the discount through 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 workers’ compensation clients.

PPO Access/Repricing

Our PPO Access/Repricing Solution provides single-source access for our workers’ compensation clients to the largest database of workers’ compensation PPOs. For these clients, we focus our efforts on providing the best PPO network matrix by area. This network matrix process ensures the best discounts in each specific state of service through an automated repricing application. We are much more than a single PPO Network Solution.

Care Management

Our Care Management Solution includes many different services, including utilization review, case management, vocational rehabilitation, and settlement services.

Our utilization review services include prospective, concurrent, and retrospective approaches based on the need of our clients. Each state has specific nuances that are addressed in the UR process.

Our case management services include on-site and telephonic services. We also deliver catastrophic case management, crisis intervention and early intervention. We also focus on return-to-work programs, as well as long- and short-term disability approaches.

Our vocational rehabilitation service eases the process of rehabilitation through labor market surveys, transferable skills analysis, loss of earning capacity evaluation, ergonomic assessments, job placement services, job analysis and modification, and expert testimony services.

Our settlement services assist our workers’ compensation clients with compliance of regulations and requirements set forth by the Centers for Medicare and Medicaid Services (CMS). The components of this solution include Medicare Set-Aside, medical cost projection and life care planning, and mandatory reporting.

Pharmacy

Our Pharmacy Solution is a specialized pharmacy management program for our workers’ compensation 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. Please click here to log in to your Health Systems International Rx Account.

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

The Health Systems International Business Intelligence Portal is an easy-to-use, browser-based application that enables our workers’ compensation and general liability 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. Through the Business Intelligence Portal, clients can access information from databases anywhere in the company so that data can be analyzed and shared in real time. The portal makes it simple to establish goals, assess 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.