Medical Bill Review

Rising’s flagship, Medical Bill Review solution is a policy preservation tool that ensures accurate reimbursement and an extension of policyholder benefits. Utilizing a three-tiered process, Rising allows clients to make well-informed, equitable payment decisions regarding their medical expenses.

First Up - Data Integrity
At the foundation of Rising’s process is the raw, medical bill data. This is where our ultimate results orginate – so it better be good and it better be accurate. Our precision in this area encompasses all aspects of data integrity, including redundancy, automated scrubbing, dynamic logic and manual intervention.

Second Up - Technology
Rising combines millions of lines of code, advanced software architecture, multiple data sources, sophisticated information management techniques, artificial intelligence tools and complex automated processes into a powerful system that helps maximize results.

Up Third - People
Rising’s technologies and automation of standard rules are a great start: providing operational efficiencies and speed. However, it takes people with training and experience to ensure you are paying no more than necessary. Rising’s bill review auditors look at the nuances of each bill and medical records, to bring our clients enhanced outcomes. Capitalizing on the expertise of our people allows Rising to produce true quality, not just quantity.

Key Program Components

• Policy review and application

• Co-payment / deductible tracking

• Extensive coding review and repricing

• Automatic fee schedule and state law adjustments

• Usual, customary and reasonable review

• Contractual provider discount application

• Customizable utilization review parameters/flags

• Robust duplicate bill detection: 99.9% accuracy vs. 85% industry average

• Aggressive fraud detection

• Seamless referrals to our Specialty Bill Review unit

• Client web portal for bill approval and reports access