As part of its broad suite of cost-containment services, HHC Group provides Medical Necessity (Bill) Reviews (MNRs) for Group Health, Auto and Workers Comp claims. Our Board certified physician specialists review medical records and billed codes to ascertain whether the services and supplies are appropriate and essential. They base their determinations on CMS and other nationally published and recognized guidelines (FDA, AMA, MCG, Cancer Institute, etc.). We do MNRs for all types of claims; prospective, post-service/prepayment and post-payment.
HHC Group also offers Experimental or Investigational Reviews to determine if procedures, technologies and pharmacology are considered experimental or investigational. Again, Board certified physician specialists use CMS and other recognized guidelines to make their determinations.
Finally, HHC Group provides Level of Care Reviews to identify discrepancies between a patient’s admission level and continued stay in combination with the patient’s clinical records. Utilizing industry standards, we determine if the confinement level is appropriate based on the patients diagnosis and the services rendered. Additionally, we review discharge criteria to assess if the patient could have been discharged earlier.
HHC Group’s Medical Necessity (Bill) Reviews, Experimental or Investigational Reviews, Level of Care Reviews and our many other cost-containment services are all designed to ensure that our clients pay only the appropriate amount for the healthcare services and supplies their members/employees receive.
About HHC Group
HHC Group is a leading national health insurance consulting company providing a wide range of cost containment solutions for Insurers, Third Party Administrators, Self-Insured Employee Health Plans, Health Maintenance Organizations (HMOs), ERISA and Government Health Plans. HHC Group utilizes a combination of highly skilled professionals and advanced information technology tools to consistently deliver targeted solutions, significant savings and exceptional client service.
HHC Group’s services include Claim Negotiation, Claim Repricing, Claims Editing, Medicare Based Pricing, DRG Validation, Medical Bill Review (Audit), URAC Accredited Medical Peer Reviews/Independent Reviews, Medical Necessity Review, Experimental/Investigational Review, Level of Care Review, , Independent Medical Examinations (IME), Case Management Utilization Review, Data Mining, Disease Management and Pharmacy Consulting.
For additional information about HHC Group and our services, visit www.hhcgroup.com or contact me at rserber@hhcgroup.com or 301-963-0762 ext. 163.
