Double Your Savings with Systemedic
Systemedic’s Professional Review and application of USAble’s True Blue PPO contracted allowances doubles your savings over a computerized repricing to the Arkansas Fee Schedule alone. Submit a secure referral today.
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Medical Bill Review and Preferred Provider Organization Network
Systemedic is a service partner with USAble Corporation, the Managed Care Organization (MCO) of choice of over 15,000 Arkansas employers, comprising 70% of the state’s workforce. 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 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.
Three-level process delivers maximum 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).
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.
Medical Bill Review Summary
AWCC Rule 30 for Medical Cost Containment requires:
- Schedules of maximum fees (based on the national RBRVS) to be paid to health care providers (hospitals, physicians, pharmacists, physical therapists, etc.)
- 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.
- 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:
- Perform ongoing UR of medical bills to identify overutilization of services and improper billing.
- Determine the accuracy of coding and recode or reprice 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.
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