WORKERS' COMPENSATION SOLUTIONS
WellRithms' medical bill review technology delivers a comprehensive suite of solutions that augment existing bill review services to address industry gaps, increase savings, and improve cost containment outcomes.
Delivering Guaranteed Savings
BILL REPRICING FOR NON-FEE SCHEDULE (UCR) STATES
Significantly lower medical expenses with our innovative solution for bills not subject to state fee schedules.
WellRithms offers specialized repricing services in Usual, Customary, Reasonable (UCR) states, focusing on bills not subject to state fee schedules. Our repricing engine aims to significantly lower medical expenses by repricing them to the reasonable industry standard. This process involves using multiple validation standards to ensure fair reimbursement that is legally defensible and backed by case law and evidentiary standards across all jurisdictions. WellRithms' approach in UCR states is designed not only to lower overall healthcare spending but also to provide a sustainable solution for clients. WellRithms offers these services in Arizona, Iowa, Missouri, New Hampshire, New Jersey, Pennsylvania, and Utah.
WELLRITHMS' REPRICING SERVICES IN UCR STATES
STOP LOSS OUTLIER (SLO) ITEMIZED BILL REVIEW
Optimizing Stop Loss Outlier Billing with Detailed Itemized Reviews Utilizing OPUS
Our itemized bill review service, OPUS, is designed to achieve additional savings of up to 40% on every bill. Outlier rules in certain fee schedule states mandate that bills at predetermined thresholds be paid at a percentage of total billed charges instead of the normal fee schedule. WellRithms ensures that payors are not overpaying by manipulating the system.
Unfortunately, some providers take advantage of outlier rules by using inflationary billing tactics to increase prices and secure higher payments. Payors unknowingly lose millions of dollars annually through this problematic loophole. Our team at WellRithms exposes these overcharges and ensures the allowed charges are accurate. Allowed charges are significantly reduced before the outlier adjustment is applied.
Our process is designed to remove services that are incidental, bundled, or included in the primary procedure. Also, we ensure charges are consistent with the hospital's reported costs submitted to the Centers for Medicare and Medicaid Services (CMS).
AIR & GROUND AMBULANCE REPRICING
Air and ground ambulance bills often come with hidden fees and complicated charges that aren’t easily understood or caught. WellRithms untangles complicated bills and provides the transparency payors deserve. Our rigorous system can spot unbundled charges and assess transport services based on medical necessity, ensuring that every bill is accurate before payment is made. We maintain the integrity of the bill so payors never pay more than a fair and reasonable price.