Rotating Quotes U.S. Medical Billing and Coding & Insurance Claims Assistance – Argus Claim Review
 

Claim Review Process

Argus in Action
– Sample U.S. Case Studies –

Health Insurance Claim/Billing:
An out-of-network hospital issues an insurance claim for $130,400.10

Reduced Medical Cost:
When ARGUS Claim Review receives an out-of-network hospital bill, we attempt to negotiate a discount. After discovering this hospital charged nearly 400% of the Medicare-allowed amount, the combination of discount negotiations and a prompt payment resulted in over $60,000 in savings

>> Save with Argus Claim Review  

Claim Review Process

Full-Scale Insurance Claims Assistance
With Argus Claim Review, all healthcare claims big and small are under scrutiny for additional savings opportunities. Those of $10,000 or more are automatically pulled for a comprehensive insurance billing audit. Because healthcare claims services are our sole focus, you can be sure that we do the most thorough job and know exactly what to look for. Our experienced team pays close attention to common focus areas and carefully watches for red flags that can often be missed without the right training.

As we go through our rigorous claim review/management process, these steps are followed to help your company realize maximum savings:

  • Review medical claims to determine the correct codes (CPT, ICD-9, HCPCS coding) are used per Medicare and AMA guidelines
  • Verify that the physician(s) billing for the services are the ones who actually performed them
  • Ensure that the charges billed are accurate and not specific plan exclusions
  • Review hospital bills/medical costs line by line for duplicate charges, coding and billing errors, pricing inconsistencies, medical upcoding, unbundled charges and other issues
  • Request to obtain medical records and conduct peer independent reviews for treatment that doesn’t appear to qualify as a medical necessity
  • Negotiate prompt pay discounts on out of network claims