Expert Out-Of-Network Bill Review - Guardian

Identifying potential cost savings quickly and efficiently.

All out-of-network bills are audited through an industry-leading medical bill review system. In addition to fee guideline application, we apply thousands of clinical edits and out-of-network bill audit functions to out-of-network bills that maximize savings for our clients.

Identifying potential cost savings quickly and efficiently.

Maximizing savings with clinical edits that uncover:

Multiple surgical procedure rules
Bundling codes that should be identified singly, but are billed separately by the provider
Aftercare days following surgery (follow-up time included in the cost of surgery)
Multiple visits or surgeries on the same day

Conflicting codes on the same day
Physical therapy code combinations
CPT – Diagnosis of code conflicts

Additional Services

Medical Bill Review

Maximize savings with advanced technologies and industry expertise.

Pharmacy Benefit Management

Helping injured workers easily obtain prescriptions and supplies while avoiding out-of-pocket expenses.

Preferred Provider Networks

Ensuring access to extensive care options through a wide network of preferred providers.

Out-Of-Network Bill Review

Identifying potential cost savings quickly and efficiently.

Durable Medical Equipment

Helping your injured employees recover at home with the vital equipment they need.

Utilization Review

Improving quality of care while avoiding unneeded medical treatment.

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