List of Common Terms

• Managed Care:
  Insurance that includes a Preferred Provider network to provide comprehensive care.
• Medical Bill Review:
  The review of medical bills for inappropriate billing practices.
• Medical Bill Repricing:
  In a database, capturing medical billing information and applying PPO, State fee or Negotiated reductions.
• Utilization Review:
  Licensed medical professionals scrutinize and evaluate medical services either provided or to be provided.
• Case Management:
  A continuous process for a patient with a catastrophic illness or injury.
• Customer Service:
  Real customer service is serviced by an individual not an answering service.
• PPO Network:
  Contractual agreement with medical providers for services.
• National PPO Network:
  Contractual agreement with medical providers for services nationwide.
• Hospital Bill Audits:
  The comparison of a hospital bill to its corresponding medical record.
• Cost Containment:
  Employing any combination of all the services involved in bill review and repricing. Case management and Utilization review to decrease the cost of an injury to the payer.
• State Fee Schedules for Worker's Compensation:
  Payment schedule indicating the maximum payment allowed for medical or medical related service rendered.
• IL State Fee Schedule for Worker's Compensation:
  On July 20, 2005, the state legislature of Illinois enacted and the governor signed a bill stating the maximum payment allowed for medical procedures.
• Medical Bill Negotiations:
  For maximum savings, non network bills are negotiated with the medical provider.
• Special Projects:
  Client Specific