Maximized Efficiency – Bill Review & Claims Services Transforming Outcomes Nationwide

Review Services

Trusted Nationwide: ExamWorks Review Services

Leading insurers, self-insured organizations, TPAs, and law firms choose ExamWorks for their comprehensive bill review and clinical audit solutions. Our national reach and expertise ensure precision and cost efficiency across every claim.

 

Bill Review & Casualty Claim Services

First-Party

First Party

Unlock the full potential of your First Party Auto claims with ExamWorks.

Our solutions offer unmatched access to a robust rules engine, a nationwide PPO network, and expert clinical and coding resources - all seamlessly integrated into our cutting-edge web-based adjuster dashboard, Nextrum.

With state-specific workflows and customizable audit processes, we partner with you to create tailored solutions that maximize efficiency, reduce costs, and ensure compliance.

National Program

  • State Specific Workflows
  • Auto Fee Schedules
  • Multi-Jurisdictional Benchmark Fee data
  • Application of Policy Limit
  • Application of Co-Pay, Deductible and Maximum Out of Pocket
  • Coordination of Benefits
  • Utilization Review
  • Verification and Follow-Up
  • State Specific Interest Calculators

National PPO Partners

  • Regional and Nationally Recognized Networks
  • Access to over 800,000 contracted physician, ancillary and facility provider discounts
  • Auto specific Provider Contracts
  • Electronically Integrated with Bill Review Workflow for fast results

Nextrum Adjuster Dashboard

  • Web Based Access
  • Customizable Adjuster Inbox
  • Color Coded Status Indicators
  • Real Time workflow View & Document Library
  • Upload Documents Directly to the Claim
  • Adjuster Control through Editable EOR

Coding and Nurse Professional Review

  • CPC Coding and Billing Audit
  • NCCI
  • Utilization Review
  • Facility Audit
  • DRG Validation

NJ AICRA

  • Nurse Case Management
  • Integrated Pre-Certification
  • Comprehensive Physician Advisor Panel
  • Adjuster Case View to Case Management Notes
  • Voluntary Networks for Pharmacy, DME and Diagnostic Radiology
  • View Partner Info & Client DPR Plans
 
Third_party

Liability / Third Party Auto Review

Transform your liability and third-party auto bill review process and streamline your claims with our comprehensive demand package review solutions, including package sorting, bill review, professional code and nurse reviews, and physician peer evaluations.

Our seasoned billing and coding experts are available to provide authoritative testimony, ensuring your case is backed by industry-leading expertise.

For cases involving future medical expenses, we deliver precise cost estimates and comprehensive support for liability Medicare Set-Asides.

Liability Demand Review

  • Three Levels to Meet Claim Needs
  • Foundational - Systematic Audit with Fee Recommendation Benchmarks
  • Professional – Includes Foundational Level and Adds Nurse Review + Professional Code Review
  • Expert – Professional Auditing and Bill Review Defended in Litigation with Established Experts.
  • Case Summary and Provider Detail Reports

Foundational Bill Review

  • Demand Sorted and Indexed with embedded hyperlinks
  • Reverse Coding for billing without codes
  • System audit of medical billing
  • Client choice of fee benchmark methodologies

Professional Review

  • Includes Foundational Bill Review
  • Nurse Auditing
  • Professional Coding review of billing
  • Narrative Report
  • Future Medical Expense Assessment

Peer Review with Bill Review

  • National Peer Review Panel
  • Used for Negotiations or Expert Testimony
  • Applies Peer Findings to Demand Package bills

Expert Bill Testimony

  • Qualified Medical Billing Experts
  • Testimony experience
  • National Footprint
 
clinical

Casualty / Clinical Review

When your claims require more than just bill review, turn to ExamWorks for professional clinical casualty services delivered by our highly skilled, U.S.-based team. We provide the in-depth analysis and expertise needed to resolve complex cases, ensuring the highest standards of quality and care.

Experience seamless support and specialized solutions tailored to your needs.

Nurse Review

  • Nurse File Review
  • Detailed Chronology
  • Hospital Billing Audit
  • Ask Our Nurse - For quick questions

Life Care Plan Review

  • Certified Life Care Planner
  • Assessment of future medical needs
  • Assists in Identifying Cost of Future Expenses

OPO Services

  • Forensic Review of Facility Billing for Donor
  • Reimbursement Calculations
  • Case Rate Comparison of Cost to Charge
  • Tissue Records Retrieval
 
technlogy

Platforms / Security / Integration

Leverage the power of industry-leading technology platforms with ExamWorks. Our secure portal ensures seamless access to referrals and return documents, providing you with a streamlined, efficient workflow.

With cutting-edge security and user-friendly interfaces, our solutions empower you to manage claims confidently and efficiently, all in one place.

Nextrum

  • Web-Based Platform for Bill Review, Document Management, Workflow and Rules Application
  • Configurable Adjuster Dashboard
  • Correspondence Library for Claims communication and documents
  • Customizable business and processing rules

Information Security

  • Hosted in ExamWorks Private Cloud Data Center
  • Multi-Factor Authentication / Single Sign-On
  • Role Based Access

Integration

  • Claim / Patient feeds
  • Document Image Transfer
  • Connected to e-billing Clearinghouse Network

Experience streamlined claims management like never before - Trust ExamWorks to deliver clarity, accuracy, and confidence in every claim and deliver results that drive successful resolutions.

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