Specialty Bill Review

The MedCost Contain (MCC) Specialty Bill Review Solution offers innovative, comprehensive, worry-free true cost containment for our clients. All designed to maximize savings while minimizing provider challenges. Our focus, experience, and accomplishments in the area of specialty review are unprecedented as confirmed by an ever broadening client base, 100% client retention, and consistent customer satisfaction ratings of excellence.

We offer innovative, comprehensive cost containment for Non-Subscriber Employers. Our Specialty Bill Review solutions are designed to maximize savings while minimizing provider challenges. Our focus, experience, and accomplishments are matched only by our superior customer satisfaction ratings and excellent client retention.

We ensure maximum savings through measures, such as application of fee schedules and billing ground rules, and negotiation of fees whenever network discounts, state fee schedule reductions or other appropriate review rationale are not available. We also help clients save through the detection of improper billing practices, such as upcoding, code “unbundling” and billing for incidental procedures; and the detection of duplicate billings at the line, bill and claim levels. Our proven approach can be used for any coverage type and results in us delivering fair and equitable savings to the payer and fair payment to the provider. Let us show you how our cost-based data analytics,expert negotiators and contractual relationships allow us to produce almost double the industry standard net savings.

Superior Product
  • Reviews performed based on objective benchmarks and standards
  • Utilizing third party data derived from over 20 million claim transactions
  • Provider specific payment, cost and reimbursement criterion
  • Financial, medical, and legal considerations integrated in each review

Exemplary Customer Service
  • Average savings of 58% on penetration rate of 98%
  • Guaranteed turn-around times
  • Prompt response for all appeals
  • Cient directed resolution "tenacity" levels
  • Claim negotiation team includes M.D., attorney and RN

We continually strive to bring cutting-edge solutions and quality service to the medical cost containment arena. With the evolving needs of Payers, we maintain a commitment to providing flexible implementation options and seamless insertion into your existing claims flow.

Objective Policies of Medical Reimbursements

  • Nationally accepted standards of reimbursement pertaining to specific medical coding
  • Incorporating reimbursement, charge and cost data reported by the specific providers
  • Prompt response for all appeals
  • Appropriate application of coding edits, modifiers and unbundling principles
  • Strategic application of “reasonable reimbursement” specific to the state’s jurisdiction
Contact Us
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