Systemedic’s professional review and the application of Arkansas Blue Cross and Blue Shield’s Preferred Provider Network contracted provider allowances [PPO], through the utilization of USAble MCO.
Your savings could double versus merely isolating your savings to
automated computer software programs that can only apply the
Arkansas Fee Schedule allowances.
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Systemedic is a service partner with USAble MCO, the Managed Care
Organization (MCO) of choice for the majority of Arkansas employers. This partnership provides Systemedic and its customer's access to Arkansas Blue Cross and 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 connects select physicians and facilities within the PPO network.
The immediate savings available are so substantial that some carriers and third-party administrators are carving Arkansas out of their national networks to take advantage of the Systemedic - USAble bill review and PPO program.
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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 44% of total savings.
Level 2: Professional Review
With Systemedic, you maximize your savings. Systemedic does not rely solely on computerized repricing to the state fee schedule. We generate additional savings for our customers through professional review by our Registered Nurses and Certified Professional Coders. Our experienced staff performs a final review of every bill, recovering extra savings from those items requiring experience and judgment to discover. Our professional review contributes approximately 12% of total savings.
Level 3: USAble MCO
Systemedic provides our customers access to the substantial discounts available through the state’s largest, most comprehensive Preferred Provider Network, Arkansas Blue Cross and Blue Shield’s True Blue PPO, contributing over 44% of total savings.
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 Department of Health (AR § 20-9-901).
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Systemedic is certified by the Arkansas Department of Health as a Private Review Agent and can meet this requirement for you if we perform your medical bill review.
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Medical Bill Review Summary
AWCC Rule 30 for Medical Cost Containment requires:
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Schedules of maximum fees (based on the national RBRVS) to be paid to health care providers (hospitals, physicians, pharmacists, physical therapists, etc.)
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Procedures to pay the lesser of (1) provider’s usual charge, (2) workers’ compensation fee schedule, or (3) the MCO/PPO contracted price where applicable.
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Carriers and self-insured employers are required 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:
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Perform ongoing UR of medical bills to identify over-utilization of services and improper billing
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Determine the accuracy of coding and re-code or reprice as appropriate
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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
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What Our Customers Have To Say
“I wanted to let you know how professional and knowledgeable your Bill Review department was during the phone call. I can't imagine trying to tackle those issues without their input and knowledge of Rule 30. We were able to express our concerns, Systemedic’s team was successfully able to back our actions up, and although there was quite a bit of push back and attempted justification, we all stood firm. I have never felt more confident going up against someone regarding the AR WC Fee Schedule than with Systemedic on my side.”
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– Claims Manager
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