WORKERS COMPENSATION SERVICES

Claim Repricing and Discounting

Workers' Compensation patients' medical bills in 46 states are paid based on fee schedules published by each of the states, not on the billed amount listed on the claim from the provider. Some providers will accept an amount below the fee schedule as payment in full. In fee schedule states (FSS) HHC Group reprices Workers' Compensation claims to fee schedule (FS) and works with providers to reduce those bills further when applicable

Medical bills for Workers' Compensation patients in the 4 Non-Fee-Schedule states are paid based on the billed charges or on discounts providers agree to below their billed charges. In non-fee scheudule states HHC works with providers to determine if their billed charges are reasonable and when they are not, to determine the appropriate charge.

HHC returns the claims for payment within 5-7 working days, unlike some companies that can take weeks to complete the process.

Fee Schedule States (FSS)

Repricing Claims to Fee Schedule

To ensure accurate repricing of medical bills for Workers' Compensation patients in FSS, we have developed our own Workers' Compensation repricing software. We have a dedicated Workers' Compensation Compliance Officer whose job it is to make sure that all updated fee schedules are loaded to our database and that they are fully tested to ensure repricing accuracy before the updates go into effect.

Reductions below fee schedule.

Some providers in FSS will accept payments less that the fee schedule amount for the services they provide when they believe it is warranted. We secure these discounts with providers in two ways: first, through discussions with the provider; and second by accessing agreements the providers have with preferred provider organizations.

After the claims have been repriced to the FS, those of sufficient size are sent to our team of attorney case managers. This team works directly with the provider to determine if they should receive the fee schedule amount or if an amount below FS amount makes more sense. Importantly, the providers supply signed confirmation that they accept the amount agreed to is accepted as payment in full for their services.

Additionally, HHC has established relationships with major national, regional, and local preferred provider organization networks (PPOs). These networks have pre-negotiated rates below the fee schedule that participating providers will accept as payment for their services. For larger claims with discounts we double check with the network to confirm that the provider is currently contracted with them and that the discount taken is correct, minimizing the potential for any reversals.

The HHC Group Guarantee

We guarantee to reprice, come to agreements with provider for amounts below FS when it makes sense, and return the claims for payment within 5 working days.

Non-Fee Schedule States

Workers' Comp patients' medical bills for the same services can vary by tens of thousands of dollars from one provider to the next even in the same market. In addition, many provider bills include errors, some of which impact the billed amount. That's why we offer our clients a wide range of products designed to ensure providers receive and payors pay a suitable amount for the provider's services.

Claims Negotiation

Upon receipt of your Workers' Comp medical claims in non-fee schedule states, our team of attorney case managers goes to work to resolve the case using our proven approach. Our team works directly with the providers – from hospitals to doctors' offices, to imaging centers. If the provider issues a bill, our team will work with them if we believe the bill contains errors or is out of line with reasonable charges for their services.

Using a proprietary database of pricing information – gathered over more than twenty five years of working with the provider or similar providers in the same market - published databases and their many years of negotiating experience, our skilled case managers work collaboratively with the provider to achieve a mutually acceptable resolution, one that results in our payors paying only an appropriate amount for the services their employees/members receive.

Importantly, the providers supply signed confirmation that the agreed to amount is acceptable as payment in full eliminating any balance billing or lost discounts.

PPO Discounts

HHC has established relationships with major national, regional, and local preferred provider networks (PPOs). When our clients submit the Workers' Compensation claims, we often reprice the claims to significantly lower rates to which providers in these networks have already agreed. For larger claims, we double check with the network to confirm that the provider is currently contracted and that the discount taken is correct minimizing the potential for reversals.

The HHC Group Guarantee

We guarantee to turn around bill adjustments in five days or less – always with a sign-off from the provider, so the price they agree stays firm.

Utilization Reviews

Every Breed of Specialist for Every Type of Review

For claims that require an independent determination of medical necessity, causation, medical appropriateness, general acceptance, or ability to return to work, HHC offers independent Utilization Reviews. With a network of medical professionals in almost every medical specialty, we're ready for virtually any type of review that comes our way.

By Qualified Medical Professionals

We have assembled a team of highly-qualified, credentialed professionals including board-certified physicians, physical therapists, psychologists and other professionals, individually vetted using stringent guidelines to ensure their fitness for rendering decisions. As a result, our team includes some of the most respected medical professionals in their fields.

Timely Turnaround

Sometimes reviews need to be expedited due to a patient's treatment plan – such as when surgery is required or a high-cost drug is prescribed. For these types of urgent peer reviews, our reviewers are available 24/7, and we provide reviews with same day, one-day, two-day, or three-day turnaround.