FOR MORE INFORMATION, CONTACT:

BILL REVIEW MANAGER Bev Chidester
TELEPHONE 501.227.5553 or 800.822.2680
FAX      501.227.6954
Click to go to USABLE PPO PROVIDER DIRECTORY

Medical Bill Review and PPO Network

Medical Bill Review is a primary cost containment resource in Arkansas workers’ compensation. Applying the Arkansas Fee Schedule, PPO discounts, and a final professional review of every bill, Systemedic maximizes savings for our customers.

Systemedic is a service partner with USAble Corporation, the MCO of choice of over 15,000 Arkansas employers, comprising 70% of the state’s work force. This partnership provides Systemedic and its customers access to Arkansas Blue Cross Blue Shield’s True Blue PPO network. Substantial discounts are available through the network with, or without, an MCO contract. In Arkansas, the MCO contract gives the option of steerage to selected physicians and facilities within the PPO network.

The immediate savings available off Arkansas workers’ compensation billed charges are so substantial that many carriers and TPAs are carving Arkansas out of their national networks to take advantage of the Systemedic-USAble bill review and PPO program.

Three Level Process Delivers Maximum Savings

  • Level 1: Arkansas Workers’ Compensation Commission (AWCC) FEE SCHEDULE — Based on a national relative value system, the AWCC Fee Schedule forms the cost containment foundation, contributing just under 49% of total savings.
  • Level 2: PROFESSIONAL REVIEW — Systemedic does not rely solely on computerized re-pricing to the state fee schedule, but generates additional savings for our customers through our nurse, pharmacist, and certified professional review. Our experienced staff perform a final review of every bill, recovering extra savings from those items requiring human experience and judgement to discover. Our professional review contributes approximately 12% of total savings.
  • Level 3: USAble MCO/PPO — Systemedic gives our customers access to the substantial discounts available through the state’s largest and most comprehensive PPO network, Arkansas Blue Cross Blue Shield’s True Blue PPO, contributing over 38% of total savings.
  • DON’T LEAVE MONEY ON THE TABLE! — Systemedic’s Professional Review and application of PPO discounts add over 50% more savings than a computerized re-pricing to the Arkansas Fee Schedule alone.

Utilization Review Is Required

  • The Arkansas Workers’ Compensation Commission (AWCC) requires carriers and self-insured entities to have a Utilization Review (UR) Program, certified by the Arkansas Board of Health (AR § 20-9-901).
  • Systemedic is Board certified and can meet this requirement for you, if we perform your bill review.

Summary of Arkansas Regulations Pertaining to Medical Bill Review

AWCC Rule 30, Medical Cost Containment, requires:

  • Schedules of maximum fees (based on the national RBRVS) to be paid to health care providers, i.e. hospitals, physicians, pharmacists, physical therapists, etc.
  • Procedures to pay the lesser of (1) provider’s usual charge, or (2) workers’ compensation fee schedule, or (3) the MCO/PPO contracted price, where applicable.
  • Carriers and self-insured employers to have a Utilization Review (UR) Program certified by the Arkansas Board of Health, whether operated by the payer, or an entity on their behalf, which shall:
    • Perform ongoing UR of medical bills to identify over utilization of services and improper billing.
    • Determine the accuracy of coding and re-code or re-price as appropriate.
    • Provide the Medical Cost Containment Division of the AWCC the name, address, and certification number of the entity responsible for conducting the carrier or self-insured employer’s UR program.