Medical Cost Containment

To better service to our clients, we have an in-house cost containment division that helps reduce the cost of medical bills and associated charges.
Health e Innovations (Hei)

  •  Average Net Medical Bill Reduction: 72.8%
  •  Average Bill Auditor Experience: 15 Years
cutting cost

Hei Services

In-House Bill Review

  •  Has access to the adjuster notes to ensure that only the work-related part of the bill is paid.

Complete Cost Containment

  •  Field Case Management
  •  Utilization Review (Prospective, Concurrent, & Retrospective)
  •  Pharmacy Network
  •  Peer Reviews

Paperless Technology

  •  Allows tracking of every document we receive.
  •  Keeps documents in a secured location.
  •  Allows claims department access to the file at any time.

Adjudication

  •  Fee Schedule & UCR Application
  •  Field Case Management, Utilization Review (Prospective, Concurrent, & Retrospective), & Peer Reviews
  •  Specialty Bill Review & Negotiated Savings
  •  Pharmacy & Ancillary Networks

Bill Auditor Tools

  •  Paperless Workflow
  •  Approval / Denial Access to Claims Adjuster Notes
  •  Access to EOB, Bill Images, & Medical Documentation
  •  Line & Bill-Level Approval / Denial
  •  Customizable Denial Reason Codes

Pharmacy Benefit Management (PBM)

  •  Early identification of risk using predictive modeling.
  •  Targeted intervention with prescribing physicians.
  •  Solutions based on “doing the right thing” for the client and the injured worker.
  •  Automated alerts for adverse trends: excessive use, inappropriate use, and cost.
  •  Constant communication and education with claims handlers, injured worker, and prescribing physician.

The complexity of a claim, along with its surrounding circumstances, can indicate the need for case management. Hei services offer:

  •  Contracts with multiple organizations, allowing for the highest quality nurses in each service area.
  •  Competitive rates and pricing.
  •  Coordination with the adjuster to match case files to the best vendor.