We believe that there are many options available for you, the healthcare payor, as you process claims.  As your professional consultants, it is our responsibility to determine what is the most cost effective treatment for each claim.

We do not just apply a percent formula to determine which review modality will yield the best savings.

Our technique of Prescreen Intervention, a line-by-line review of the itemized charges submitted by the provider, identifies the proper course of action.  Below, we explain the following options:

(More about the DMI A.U.D.I.T. process within this web site.)

Negotiations on hospital and physician/surgical charges are sometimes recommended as the most cost effective route to claim closure.  Negotiations are not considered final until agreed to in writing by the service provider, and each case is signed off in a report to you that summarizes the outcome.

DRG (Diagnostic Related Group) Review identifies the accuracy of the codes applied by the provider to a hospital bill.  Our Review Clinicians assess each code for accurate assignment, verify all comorbidity applications, and correlate the relationship between upgrading modifiers and the primary diagnosis and procedure codes.

Physician Advisor Consultations address the usual and customary database, medical necessity, length of stay, causality, IMEs, peer reviews, and personal injury/disability claims.

Worker Compensation Claim Reviews can include ambulatory surgical center audits, hospital bill audits, causality as well as investigations and surveillance.