As a state with no established fee schedule, managing Wisconsin’s medical costs can prove challenging. Rising’s certified database – ClearChoice®-Wisconsin – provides a game-changing solution to optimize payer outcomes.
ClearChoice®-Wisconsin Gives Payers Repricing Capabilities
Wisconsin ranks among the highest for workers’ compensation medical reimbursement rates per procedure in the nation. With no published medical fee schedule and an employee’s choice of medical provider, payers’ options for medical cost containment are limited in the State.
To address this limitation, Rising developed ClearChoice®-Wisconsin, one of the State’s select few certified database services available for repricing workers’ compensation medical charges.
How does it work? By leveraging regional groupings, benchmarking data, and proprietary data intelligence tools, Rising analyzes medical treatment data to calculate fair provider reimbursement rates that are highly successful in defending reductions to the Department of Workforce Development (DWD). These analyses produce comprehensive data sets by processing millions of data points, geographically-specific data, and regionally-defined methodologies. The ClearChoice®-Wisconsin database is loaded directly into Rising’s bill review software, where it is utilized to reprice Wisconsin bills to the fairest rate available, generating superior cost savings.
Five (5) key differentiators allow payers to improve their savings with ClearChoice®-Wisconsin:
- Leverages 20+ years’ experience developing, updating, and maintaining ClearChoice®-Wisconsin, one of the State’s few certified databases
- Holds six (6) facility and non-facility certifications
- CPT Professional Database
- HCPCS Professional Database
- CPT Ambulatory Surgical Centers
- CPT Hospital Outpatient
- HCPCS Hospital Outpatient
- Follows all regulatory guidelines regarding certified databases and uses DWD specifications when submitting updates to the State
- Delivers extensive coverage for medical fee codes in the State by applying 1.2 standard deviations above the mean in computing certified formula amounts for all databases
- Covers all Wisconsin providers that service workers’ compensation patients
- Provides enhanced discount opportunities by taking advantage of all available tools in the marketplace, which empowers payers to improve their bill review savings in Wisconsin
ClearChoice®-Wisconsin is available through Rising’s medical bill review program or it can be accessed as a standalone data service.
“ClearChoice®-Wisconsin addresses a vast number of medical fee codes, giving our Wisconsin customers access to comprehensive and superior discounts in the State.”
– Dan, Chief Information Officer