Specialty Bill Review
Ensure Fair and Reasonable Pricing with Specialty Bill Review
Enlyte’s specialty bill review solution provides usual and customary pricing to help payers consistently pay a fair and reasonable price when fee schedule pricing does not exist. Our specialty bill review (SBR) solution provides a workers’ comp-only pricing methodology that is used most optimally in states where fee schedule pricing does not exist, or there is a gap. SBR pricing is based on 20 unique data sources that help to triangulate a fair and reasonable price using provider-specific results and profiling data.
Providing Precision in Medical Billing
Navigating the complexities of medical billing can be overwhelming. Our innovative solution brings clarity, fairness, and efficiency to your bill review services. Specialty bill review offers a comprehensive approach for adjusters, optimizing medical billing practices. By integrating usual and customary pricing, automating error detection, and delivering deep insights into provider practices, it empowers adjusters to make informed decisions with confidence.
Key Metrics
60K+
Bill Volume
$251K+
Total Savings
56%
Savings Rate
$4K+
Average Savings Per Bill
Here’s how specialty bill review can transform your medical billing experience:
Automated Pre-Screening
Our system intelligently automates the pre-screening of medical bills, identifying often-missed errors and abuses. This not only maximizes bill volume within the same turnaround time but also enhances accuracy, reducing the risk of overpayment.
Provider Profiling
Specialty bill review goes beyond surface-level checks by helping identify problematic billing practices. Through provider-specific results and profiling information, it offers a deeper layer of insight, enabling more informed decision-making.
Comprehensive Review Process
We apply reason codes, rules and flags for nurse-level review, ensuring that every aspect of the bill is meticulously reviewed. This multi-tiered approach guarantees that only justified charges make it through.
Mathematical Evaluation
Our advanced algorithms evaluate data to determine what would be considered “fair & reasonable.” This mathematical rigor adds a layer of objectivity to the billing process, ensuring that all assessments are grounded in solid data.
Key Differentiators
- Enlyte-owned software with deep integrations across all solutions
- Recommendations are supported by our dispute resolution team made up of registered nurses, medical coders, data scientists and compliance experts
- Quick implementation customized to fit your needs
- Automatic routing to the negotiations team using pre-built integrations for quick handling
Specialty Bill Review Coverage by State
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Combine industry-leading technology and expertise to achieve exceptional claim outcomes. Schedule a consultation to learn more about our comprehensive suite of integrated casualty services and solutions.