While many TPA’s outsource medical bill reviews, Salus’ in-house team of experts work hand-in-hand with our claims team–and our customers–to deliver an essential tool for reducing work injury medical costs.

Starting with claims systems integration, we use powerful software to ingest and adjudicate medical bills, then reprice to state mandated fee schedules as well as usual and customary rates, and ensure that negotiated provider discounts are applied, duplicate billings are caught, and dollars are not paid out for services that were not authorized in utilization review decisions.

Then our advanced, customizable rules engine either allows straight-through processing of bills, or rapidly routes them for expert review to our senior auditors, who in-turn, refer complex hospital reviews to trained clinicians.

This wealth of hand-on-experience gives us unique perspective–and capabilities–when managing work injury claims. We've embeded this knowledge into all of our processes and systems, using advanced data-analytics to constantly improve results.

Features and benefits

• Medical bill review services for all fee and UCR schedules across jurisdictions nationwide
• The most comprehensive preferred provider network in the country reduces hospital and physician bill costs
• Nearly 30 years of workplace injury expertise
• Complete artifact capture, including mailroom and e-bill intake
• Document imaging for fast, accurate medical bill processing
• Automatic classification by document type
• Validation of OCR and/or keyed data
• Client configurable rules engine enables custom rules and workflows that increase straight-through processing of bills and route exceptions for review
• Software guided review, repricing and compliance by bill review and compliance experts
• Integrated utilization review for increased auto adjudication of bills
• Substantial reductions on medical billing through our analysis of charges and length of stay against several data points, from which an appropriate and fair final bill can be negotiated
• Adjuster Portal increases adjuster productivity with a range of interactive tools that provide real-time visibility and control
• Up-to-date fee schedules, PPO network agreements and regulatory requirements
• Regulatory reporting including full service NCCI Medical Data Call Reporting and Medical EDI State Reporting
• Ad-hoc reporting tools to easily develop and deploy custom reports

At a glance

SAVINGS
60%		Average, defensible net savings
RETURN ON INVESTMENT
1,880%		For every dollar spent on bill review
TURN-AROUND TIME
< 3 days		Faster than state mandates 98% of time
DISPUTES
< 2%		results questioned by originating provider