Managed Care

Advanced technology.
Expert review.
Personal service.

With decades of work injury expertise and direct access to claims data, Method's medical bill review program is a linchpin in our managed care strategy.

While many TPA's outsource medical bill reviews, Method's 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. This close collaboration, combined with tightly integrated technology allows us to maximize savings while still achieving the best possible outcome for injured workers.

Starting with claims systems integration, we use powerful software to ingest and verify 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.