HOTLINE AGREEMENT FORM WITH FEESTESTIMONIALSHOW TO SUBMIT A CLAIM FOR REVIEW

Medical Claims Review HOTLINE

Your Ultimate Resource When Complex Claim Issues Arise

Free Screening
Complex Claims
HOTLINE Report
HOTLINE Savings
HOTLINE Specialist
Focused Medical Review

Free Screening
Call the HOTLINE with your complex claim.  Our Claims Specialist provides initial guidance on the telephone at no charge.  Often this is all you need to make your decision.  However, many claim issues are too complicated to be addressed over the phone.  When an in-depth review of your claim is in order, we ask you to send in a complete copy of the claim and supporting documents, including relevant benefit plan definitions.  Don’t worry, confidentiality is assured as we are HIPAA compliant and will be happy to complete a Business Agreement.

Complex Claims

While we review almost any type of medical claims issue,certain types of claims and claim issues are most effectively handled through HOTLINE services.  These types include, but are not limited to: 

• unbundled surgical claims,
• medical necessity,
• pre-existing,
• eligibility,
• upcoding,
• overutilization of coding or billing,
• fraud and/or abuse,
• potentially cosmetic or excluded/limited by the Plan,
• interpretation of plan document,
• possible experimental or investigational treatments,
• denials and ERISA appeals, and
• other claims which require a second opinion.
  

HOTLINE Report
Our in-depth HOTLINE review delivers:

• A comprehensive summary of the information submitted to us;
• An outline of the steps taken in the course of our review and the rationale behind them;
• Detailed analysis, including specific references to plan language, providing a clear explanation of our opinion and recommendations; and
• A monthly status report outlining the files we’ve reviewed and the savings we’ve identified.

HOTLINE Savings
HOTLINE clients have seen consistent savings of 20 – 50% on the claims submitted for review.

HOTLINE Specialist
Every claim is initially reviewed by our HOTLINE Specialist, who has proven experience in medical claims procedure, plan language interpretation, investigation, and auditing.  Further, our Specialist has technical expertise in the field.

Many of the claims we review concern plan language interpretation.  Our Specialist addresses the issue of plan language, if provided, in every HOTLINE claim report.

Focused Medical Review
Claims requiring focused medical review are referred to one of our Physician Specialists for an opinion.  Our specialties include, but are not limited to:

• Neurology (Pain Management),
• Dentistry,
• Endocrinology,
• Internal Medicine,
• OB/GYN,
• Ophthalmology,
• Orthognathic,
• Otolaryngology,
• Podiatry,
• Speech Pathology, and
  
• Psychiatry

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