Medical Bill Review and Repricing Services a. Receive all medical bills and records in digital format via SFTP server on a daily basis. b. Deliver all adjudicated and/or repriced bills including data and .pdf files via data bridge with Knox County’s claims software, Origami Risk, for accessing, processing and storing. c. Indexing of all medical bills and reports. d. Requesting needed documents for incomplete bills from providers. e. Verifying all billing CPT codes comply with actual treatment provided. f. Identifying treatment that is not appropriate under the AMA guidelines. g. Monitoring and identifying duplicate bills. Sending those previously reviewed bill(s) to providers along with EOR marked duplicate. Send zero payment EOR to provider and provide justification for zero payment. h. Repricing of bills in accordance with State fee schedule and/or PPO contracts. i. Repricing of bills pursuant to amounts agreed by contract between Knox County and certain medical providers. j. Completing the review process for all medical providers’ bills within 5 working days of contractor's receipt of bills; and for all hospital bills within 10 working days of contractor's receipt of bills. k. Reviewing appeals of medical bills from providers and making recommendations to Knox County. l. Assisting with testimony and/or other professional services on all medical bill issues on litigated cases including justification of payment and payment amount, up-coding or down-coding and any other required services related to this contract and requested by Knox County. m. Providing on a per claim basis all scanned documents in PDF format only including medical bills and reports to Knox County.
