The HealthCare Industry Back Offfice

Work Comp Review

RapidCare Review Services:

Our Review experts leverage process and technology best practices to assist clients reduce non-compliant expenses; streamline and reduce bill review cycle times while giving an increased ability to achieve early discounts. The RCS team offer a full outsourced solution to help the client appropriate tasks to unbundle and utilize a delivery model that make the best use of all available resources to achieve your goals. Services are delivered effectively on assigned work offering jumpstart expertise, experience, and efficiency to maximize the value of your outsource cost.

Improve Efficiency, Quality and Outcomes:

Rapid Care Medical Review teams provide capabilities to deliver an optimized processing platform more specialized and adapted to your workflow and coherently providing you enhanced control, productivity, flexibility, response time, and cost containment advantages.

Starting from the First Report Of Injury component, the claim can be directed to routine work including rapid entry and extensive data capture of loss information, occurrence and injury details, claimant details, wage details, state specific data, claim related information including treatment, before performing comprehensive medical record review and summarization, and bill review leveraging data collection, and managing review to established guidelines and rules.

Capabilities for the following provide you an optimized strategy eliminating redundant data entry, improving data accuracy, and validating along your adjudication process throughout the claim life cycle while keeping your knowledge teams focused on high value tasks while Rapid Care handles all the routine work.

Capabilities:

First Level Utilization Review based on Criteria and Guidelines.

Medical Bill Entry and Re-pricing. [Medical Bills, Prescription Bills, Hospital Bills, Rehab Medical Bills]

Medical Record Review and Chronology including pre-injury and post-injury sections.

Comprehensive Code review to identify incorrect codes, improper assignment, misapplication, and more.

Document sorting, categorization, chronology, and indexing.

Highlights:

First Level Utilization Review for most services including Medication, Physical Therapy and Rehabilitation, Imaging and Diagnostic Studies, Procedures and interventions, and more to ensure that the proposed treatment is appropriate for the extent of injury. Each request is scrutinized along with its set of medical records detailing treatment received from date of injury to present.

Medical Bill Re-pricing, Fee Schedule review, Usual & Customary review, Line by Line review, and Physician led record review and specialty review.

Claims are reviewed for special actions such as pre-authorization, medical visit type, mutually exclusive procedures, incidental procedures, single code, pre-operative and post-operative code assignments, clinical duplicate procedures, and bi-lateral procedures, and more.

Diagnosis review, prescription review, and comprehensive medication review.

Features:

Services are provided based upon a specific need and adhere to your claim procedures. Rapid Care has experience in delivering high value projects and working within the Workers Compensation industry for the states of California, Texas, and New York.

You receive immediate and sustained services for medical, disability, and litigation claims ensuring timely and cost effective outcomes.

ISO 27001:2013 certified information security management ensuring confidentiality, integrity, and availability.