TRISTAR Managed Care (TMC) Medical Bill Review procedure analyzes and reduces medical bills to fair and equitable amounts. We go two steps further than most other bill review vendors: 1) level of service review – by reading the medical reports, we make sure the services billed were the services rendered. This process allows our clients to save more; and 2) a 100% second audit – when a bill review is completed, it is audited two (2) more times to assure 100% accuracy. TMC reviews all types of medical bills including, but not limited to, medical provider bills, facility fees, prescription invoices and durable medical equipment invoices.

TMC reviews medical provider bills, facility fees, prescription invoices and durable medical equipment invoices. TMC has a comprehensive method of verifying the appropriateness of provider charges and whether those charges adhere to the State-mandated fee schedule or local Usual and Customary reimbursement levels.

Statistics show that over 50% of the costs of the employer’s Workers’ Compensation Program is for medical benefits. Medical treatment and prescriptions must be closely monitored to reduce workers’ compensation costs. TMC savings average is well over 50% for all types of medical bills due to high-level, experienced analysts.

High Level Analysts

TMC has highly trained analysts who review any unidentified or complex procedures prior to processing. An invoice analysis is prepared listing the actual amount of bills, overcharges, allowance recommendations and rationale for all reductions applied. When a medical invoice is reduced, TMC’s phone number is printed along with a rationale on the Explanation of Review (EOR). The medical providers direct their questions to TMC. TMC handles all billing disputes, helping to eliminate the clients’ involvement, and the involvement of the administrator. The TMC system allows us to input any special discounts arranged by the client and their designated providers.

BillChek

BillChek is designed to accurately re-price bills for outpatient facilities, surgery, pain management as well as new and unusual diagnostic and therapeutic services. By comparing the surgery bill in conjunction with the facility bill, unjustified overcharges is prevented. These bills consist of 5% to 10% of the total number of bills but drive up to 30% of total medical costs. BillChek provides an alternative to non-fee schedule procedures as follows:

• Ambulatory surgery centers (ASC’s) facility fees
• Outpatient surgery professional charges
• Pain management services, including injections and therapy

Negotiated PPO savings for these non-fee schedule services are typically 10 – 20% of billed charges. BillChek eclipses these results with an average of 75 – 80% reduction on these types of bills. Our sophisticated and comprehensive database adjudicates the provider bill to the usual and customary allowance, adjusted to geographic location. The rules engine is updated continually based on provider billing practices and controls abusive and unrestrained unbundling of charges.

Additionally, through our bill review scanning system, we will be able to offer in the near future, the capability for the client to view the original scanned image of the bill along with the corresponding Explanation of Review (EOR). This will be available via internet access.