Our Managed Care Gateway Handles Bill Review, PPO Processing and State-Specific Negotiations
December 22, 2024

You may have read in this space about the efficient claims processing capabilities Acrometis has developed. What you might not know is we also offer cutting-edge bill review and re-pricing solutions. Just as our claims processing platform CLAIMExpert, reduces inconsistencies and errors, our premium network Managed Care Gateway automates and streamlines bill review for your organization. The Managed Care Gateway bridges claims operations and top-tier providers, removing manual review when determining whether a bill is legitimate, related and should be paid. This automated bill review system is available as an individual platform, and it also can be made even more powerful with some additional options described below.

Bill review is subject to numerous pitfalls like the tedious and human-error-prone manual sorting process, and the fact that multiple systems are often involved. Our bill review services eliminate those issues while dramatically reducing bill review charges. Not only does our Managed Care Gateway slash those charges, it also ensures they are valid, while meeting the specific timeframes required in each unique jurisdiction.

Our automated system flawlessly and instantly evaluates each bill, line-by-line, based on a set of pre-set rules based on the type of injury, associated body parts and provider billing for the claimant. The provider charges are then reduced to match a predetermined fee schedule or usual, customary and reasonable (UCR) charge amount. The MCG system can even perform manual audits on bills requiring further review before being validated, if needed. For auditing purposes, each “decision” made and each action taken by the system is time-stamped.

Acrometis negotiated agreements with the top-rated PPO partners in the industry, enabling us to deliver the lowest-possible rates to our customers. We receive your claim feed, convert images, and then send re-priced data back to your systems – all over and above bill review.

Finally, through an additional re pricing negotiation service, Acrometis manages workflows centered around,payment negotiations and payment monitoring that are specific to each state’s individual rules and regulations. Another add-on feature, we work directly with providers to obtain signed provider agreements while securing the most advantageous rates.

Stop paying more than you should in medical costs. Harness our unparalleled expertise in determining the compensability of bills. Learn more about Acrometis and our bill review solutions by clicking here.

Get the WCInsights Newsletter!