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MES Medical Bill Review
MES Bill Review software employs leading edge technology that allows automated, consistent claims adjudication against standards set by our national database, state-mandated fee schedules and our proprietary rules/ UR flagging engine.
Our PPO Networks: |
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- Over 325,000 providers in 50 states
- Rigorous credentialing/ re-credentialing practices
| State |
Examples of PPO Savings |
| |
In Patient |
Out Patient |
Physician |
Ancillary |
| California |
23% |
24% |
33% |
27% |
| Florida |
24% |
26% |
29% |
24% |
| New Jersey |
18% |
22% |
26% |
24% |
| New York |
24% |
17% |
35% |
33% |
| Texas |
20% |
23% |
24% |
24% |
| Washington |
17% |
19% |
25% |
22% |
Utilization Review Flags and Rules
The MES Medical Bill Review engine automatically flags potentially inappropriate treatment.
Examples of Utilization Review Flags:
- Maximum frequency per day
- Frequency and duration of services
- Frequency of visits
- Number of codes billed
- Dollar limits
- Bill type and coverage type
- Provider and provider degree
The sophisticated rules engine assists clients in identifying unrelated and unnecessary medical treatment once services have been billed, but prior to payment.
By flagging bills in our review system, MES Medical Bill Review can alert the Client to potential over-utilization issues. The MES Medical Bill Review system also works seamlessly with our Peer Review solution to provide an effective physician review of medical care and related charges. Physicians and Allied Health Professionals provide an objective written opinion on the services in question that can assist in payment determination.
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