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Medical Claims Review

Medical Claims Review

Medical claims review helps ascertain that provider billings are accurate, reasonable and appropriate for services provided. Managed Outsource Solutions (MOS) can help you with systematic, customized medical review service that includes evaluation of provider claims. Our services are available anywhere in the United States, and we have worked for a variety of clients including insurance companies, law firms and physicians. We conduct an in depth review of medical claims, perform medical claims audits, and efficiently process them for the purpose of determining medical necessity, appropriateness and efficiency of services.

Interested in a free trial? Feel free to call our toll free number: 1-800-670-2809 for clarifications and further information.

Medical Claims Review Process

at MOS
  • Reference the medical record documents' tab and identification numbers
  • Reference the claimant
  • Reference important dates [date of incident/injury, dates of service in question etc.]
  • Classify relevant information from each medical record
  • Sort and index the medical records
  • Obtain information from all relevant medical records to the required level of detail
  • Review information
  • Tabulate information from the provided medical records and lay them out in an easy to follow format
  • Develop chronology and time-line

MOS' review process helps determine patient eligibility, whether the claim has been sent within the payer's time limit, whether preauthorization/referral numbers are present as required under the payer's policies, and other details. It also helps identify non-covered services that have been billed, valid code linkages, concurrent care, bundled codes and services that are medically unnecessary.

Advanced Technology and Dedicated Workforce

At MOS, we utilize advanced technology, and have on staff highly trained personnel who have years of experience working on the clinical side of the industry. They are trained in the payment policies of diverse payers. Our team reviews the claims and ensure that there is clinical documentation that provides details of the providers of service, places of service and dates of service. They will check whether the treatments provided were appropriate and logically follows the facts and conditions shown in the medical records, and that all services provided have been accurately reported.

Every medical claims review report passes through strict quality assurance processes. Our medical experts and quality control staff work as a team to make the overall process faster, easier and more efficient. Your solution can be all or any part of your process and our medical records solutions are customizable.

Contact us at 1-800-670-2809 to benefit from our 24/7 service. Enjoy cost savings of 30 - 40% and the service of some of the best medical record review professionals in the industry.