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Internet Applications: webMBR
Internet based medical bill review represents one of the most innovative applications of web services technology in the medical cost management industry. The return-on-investment for organizations deploying this new approach to controlling claim expenses will certainly be viewed as one of the most successful cost reduction strategies of the new millennium.
@Global's web services engine consolidates all state fee schedules, UCR databases, and participating preferred provider networks into a central data library. This brand new transaction-processing environment interfaces real time with medical bill review data that @Global customers (insurers, employers, care management organizations, third party administrators and preferred provider organizations) submit or access in several different ways:
- Via webMBR, an Internet browser based application from @Global
- From Allegro, @Global's client-server claims, care and medical cost management application
- Companies may license and embed @Global's web services re-pricing algorithms into their own applications
The process also integrates medical cost management industry "best practices" by automating medical bill review rules and reimbursement guidelines. Nearly every claim reviewed will be impacted by this new technology, and result in significant medical expense savings. In addition to these savings, customers will realize significant operating cost reductions and service level enhancements, including:
Information Technology Benefits
- Eliminate Hardware Costs - Avoid the cost of buying additional database and application servers.
- Eliminate Software Costs - Save the costs associated with workstation license and installation fees.
- Eliminate Data License Fees - webMBR already includes nationwide Fee Schedule and UCR access.
- Optimize IT Salaries - @Global manages all system maintenance, software upgrades and data file updates.
Medical Cost Containment Benefits
- Fee Schedule and UCR Review - Routine Fee and UCR schedule updates assure benefits are paid correctly.
- PPO Network Access - webMBR allows access to major PPO networks and contracted discounts.
- Medical Review Rules - Second generation rules engine verifies payment for only medically appropriate and necessary care, including alerts for duplicate bills or services, code bundling/unbundling, modifier reductions, multiple procedure discounts, surgical follow-up days, and procedure code modifiers.
Claims Management Benefits
- Eliminate Payment Delays - webMBR reviews bills in real-time via a standard web browser. Re-pricing results, Explanation of Benefits and savings reports are now available in seconds.
- Reduce Payment Status Inquiries - By eliminating MBR outsourcing programs, users can improve turn around times and instantly respond to inquiries as webMBR allows real-time access to all bill history.
- Explanation of Benefits - A clear and concise EOB report is available online. The report can be printed individually or in batch mode, and exported to automate payment and claims cost allocation functions.
- Activity and Savings Reports - Managers and customers benefit from the extensive on-line reports menu, including network utilization, claim cost allocation, provider activity and user productivity reporting.
Click here to see the WebMBR Diagram
| Data Entry Formats |
Standard HCFA 1500 and UB-92 |
| System Integration |
Organizations can download provider, claim, patient and eligibility data to increase data entry productivity. |
| Turn Around Time Tracking |
Received date field enables performance management tracking. |
| Medical Payment Reserves |
All transactions default to a Medical Reserve category, and the user selects from a client definable Payment Code table. |
| Diagnostic Coding |
Up to four codes can be stored during each review. |
| State of Jurisdiction |
All transactions default to the state in which the services are performed, but the user can select an alternative jurisdiction and Fee Schedule. |
| Transaction Data |
Medical procedure details include date-of-service, type and setting of service, procedure code, modifier code, units, charged amount, allowed amount, paid amount, state tax where applicable, explanation of benefit codes, and PPO discount. |
| Medical Bill Rules |
A second generation rules engine automates many of the re-pricing decisions critical to optimizing medical benefits and medical loss costs, including follow-up days, procedures not related to patient condition or covered diagnosis, multiple procedure rules, modifier based reductions, procedures not related to provider specialty or medical authorization. |
| Duplicate Services or Bills |
Web services automatically alerts the user when duplicate dates, services or bills occur during processing. |
| Explanation of Benefit (EOB) |
A standard EOB includes all pertinent patient, payor, provider and PPO demographic information, medical re-pricing details and explanations, ad hoc comment section provides additional payment information, statutory statements and references, and customer service contact information. The system supports the printing of individual or batch EOB requests. |
| Easy Payment Methods |
Clients may establish a pre-funded account and designated users. Web services automatically alerts the user when insufficient funding occurs. |
| On Demand Reports |
A robust web-based reporting menu includes network utilization profiles, user activity reports, provider cost management summaries and claim level detail reports to facilitate claim cost allocation requirements. |
| NATIONAL Rate Schedules |
Automatically reprice bills to all workers compensation and automobile fee schedules, UCR schedules and national PPO network discounts. |
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