Ics Services Overview Template Wc


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Integrated managed care solutions with industry leading resultsProprietary technology solutions support optimal resultsUnique global and specialty PPO network solutionsInnovative service offerings and flexible pricing termsService pricing at "wholesale rates"
  • Dedicated and on-site unitsPer line, per bill, % of savingsCombined bill review/PPO flat fee per billSoftware leasing options
  • Ics Services Overview Template Wc

    1. 1. Innovative Claims StrategiesIntegrated Medical Claims Management Program Overview Prepared for: September 1, 2011
    2. 2. Corporate Overview Genesis of ICS Disability and medical care management services Leader in technology-driven, early intervention case management services Extensive experience within both public and private sector, risk pools, carriers, third party administrators, self insured/administered, and transportation industry Comprehensive and innovative technology solutions, including extensive interface capabilities Documented savings and results Flexibility to customize all aspects of service to ensure programs meet unique needs of each client Our principle objective is to deliver innovative, integrated, and technical strategic services to our clients that result in outstanding program outcomes We create our services as a branded business model, not a commodity 2
    3. 3. Capabilities Overview Covered Lines of Business: Workers’ Compensation  Longshore/Jones Act  Auto  Liability  FELA  Group Health Our Branded Service Product Lines: 3
    4. 4. Our Service Capabilities Overview 24/7 Case Initiation & Absence Management  Medical File & Demand Package Reviews Call Center  Independent Medical Evaluations Early Intervention Telephonic Case  Physician Advisor (PHAD) and Peer Reviews Management - Concurrent UM  Pharmacy & Durable Medical Equipment Catastrophic & Task Based Field Case Programs Management  Medical Record Retrieval Pre-Certification/Prior Authorization –  Arbitration & Litigation Support Prospective UM  Investigative & Surveillance Online Medical Bill Review with Fusion  Subrogation & Third Party Recovery PPO-ICING  Transportation & Translation & Transcription Out of Network IRON Signed Agreements  Technology Suite Specialty Bill Review – Retrospective UM  Program benchmarking, data collection, & Medicare Set Aside – Comprehensive Solutions analysis 4
    5. 5. Competitive Advantages Extensive managed care industry knowledge Integrated managed care model with demonstrated results Customized, flexible programs helping clients meet objectives Complete transparency in all service component PPO ICING combines disparate networks Proprietary, integrated technology solutions Dedicated implementation and customer service team 5
    6. 6. Our Integrated Service Business Model iCORE (Integrated Circle of Excellence)  PPO Management  Fraud Abatement  Record Retrieval  Field Case Management  Transportation  Translation (Telephonic, Traditional, On Demand)  Vocational Rehabilitation  Subrogation  Impairment & Disability Ratings  Pharmacy Benefit Management Programs  Wellness & Recovery iSYS (Integrated Systems)  Data & Image Repository iBOSS (Integrated Back Office Service Solutions) 6
    7. 7. Integrated Medical Claim Management – Our Approach Our primary approach is to deliver innovative, integrated, and technical strategic services to our clients that result in outstanding program outcomes fused with stakeholder satisfaction creating a branded business model, not a commodity Our claims management approach includes Medical and Disability services to manage each dimension of a claim that affect overall costs to achieve program efficacy We adapt our technology and processes within the program to match the specific and unique characteristics of our clients and any jurisdictional or legislative requirements, along with the endorsed case management techniques typical of a given state Our services within the program are scaled to match our client’s desired distribution of process between its internal staff and the ICS professional staff Our model is composed of services that begin with the first notice of injury and encompass prospective, concurrent, and retrospective care management industry best practice techniques 7
    8. 8. Integrated Medical Claim Management – Our Approach 8
    9. 9. Call Center Services 9
    10. 10. Call Center Services - Component Benefit Promotes Early Intervention with prompt notification of injury, illness, accident and/or absence Dedicated Toll-free number available 24 hours a day/7 days a week Designed to complete all mandatory and client specific reporting forms Allows for immediate verification and access of information via Auto Email Alert process and WebOPUS Browser technology Designed to eliminate paper & labor intensive processes Improves timeliness of reporting of injury, illness, accident and/or absence, allowing for Care Management to begin immediately Provides for Mandatory and/or “Soft” channeling to appropriate PPO/EPO Network provider Provides for “Call ahead” process to the appropriate facility Provides for Flagging between various payment systems 10
    11. 11. Impact of Early Intervention - Average Medical Cost by Lag Time CategoryFor Client A, new injuries that are reported 8 Days of Greater incurred roughly 140% more in medical costs than those cases that are reported the Same Day. 11
    12. 12. Early Intervention Case Management 12
    13. 13. Early Intervention/Telephonic Case Management The control process in the Integrated Medical Management Program is the Telephonic Case Management component Prompt and concurrent review and management of the medical care of injured employees ensuring the utilization of the best and most appropriate medical care Timely and continuous contacts with injured employee, work site coordinator, medical provider, and claims adjustor until claim resolution promoting effective communication Focused return to work coordination by managing the disability duration of injured employees compared to national best practice guideline Promote employee advocacy and goodwill Forum for Program Introduction & Expectations 13
    14. 14. Early Intervention/Telephonic Case Management Upon completion of an Initial Assessment, Nurse Case Manager will evaluate:  Medical Management • Treatment Plan • Disability Duration  Return to Work Plan • Pre-Authorization/Utilization Review  Necessity for Peer Review, Independent Medical Evaluation or Field Case Management Continuously update work site coordinator, claims adjustor or any other interested stakeholders with care management milestones via:  EDI to Claims System  Email Alerts to all interested parties  WebOPUS Browser accessibility 14
    15. 15. Promoting Early Intervention - The ICS Health Ticket Transparent claimant, provider, and employer tool, customizable by client Consolidates all prospective services (pharmacy, PT, imaging, DME) into an ID card Created through a claim file feed or in real time through a customized web-site Incorporates panels to improve compliance and direction of care Increases utilization of prospective programs and PPO penetration, reduces out-of-network management cost Enhances quality of care and improve claim outcomes 15
    16. 16. Average Lost Time Days by Closed Lost Time ClaimCY 1999 was the year prior to implementation of current ICS program. Over the past 11 full calendar years, theAverage Lost Time Days on Closed Lost Time Claims is 27.5, 53% improvement measured against CY99 results. 16
    17. 17. Pre Certification/Utilization Review Services 17
    18. 18. Prospective Utilization Review Overview Detailed determination reporting with complete clinical rationale and treatment guidelines used for decision making Our Technology allows for a seamless and fully integrated data exchange ensuring Authorization outcomes are embedded automatically for future reimbursement activity Pre-certification Model  Medical Necessity Review  Full utilization management including concurrent review Physician Review Model  Criteria based referral  Peer to peer board certified specialties  Independent Medical Evaluations Case Management Model  Early Intervention  Field Case Management as necessary  Cost Projection 18
    19. 19. Medical Bill Review & PPO ICING &Out of Network IRON 19
    20. 20. Medical Bill Review Services ICS has emerged as a unique national medical bill review alternative for Insurance Carriers, Third Party Administrators, State Funds, and Self Insured Employers by providing flexible service delivery through our innovative technology, business model and offering access to national and specialty PPO Networks ICS utilizes an internally developed and proprietary medical bill review software, that utilizes highly flexible technologies as the basis for an extremely powerful and robust pricing engine Carefully balancing the efficiency of automated pricing functions with the opportunity for intervention, control, and customization as required, ICS is able to meet the diverse needs of the Workers’ Compensation, Auto, Liability, FELA, FECA, and Longshoreman & Maritime Industries 20
    21. 21. Medical Bill Review Services Mail Room & Claim Indexing  Out of Network IRON (Increased Document Management, Storage, Results On Negotiations) and Retrieval – Paperless Solutions  Rules Based Technology creating Operational Throughput (iSTEP Client specific Exception based Environment) workflows e-BRIDGE(Adjuster Online Bill  Customized Adjudication Protocols Approval Dashboard)  Real Time Integration between all Real time interface that feeds stakeholder applications outcomes from Prospective Pre  Real time, web based management Cert to apply Retrospective Bill reporting Review Pre Cert Flags  Custom/Ad hoc/State Reporting Fee Schedule/UCR adjudication  Provider Assistance Hotline PPO ICING with Fusion  Automated Check Writing Nurse Audit & Code Review 21
    22. 22. Rules-Based Process ICS performs bill review services using a rules based software application that sequentially applies a list of repricing considerations, as shown below, to each set of submitted charges that constitute a medical bill  User-configurable rules engine  ICD/CPT Procedure Code Matching/Crosswalk  Redundant or Duplicate Charges  PPO Network ICING Application  Improper Coding  Out of Network IRON  Jurisdictional Rules Application  Utilization Guidelines  Automated Medicare CCI / OCE  Pre Certified Treatment Plans / MUE  Case Specific Denials  Reserve Limits  Fee Schedule/UCR Calculation  Client Defined Flags 22
    23. 23. Network Solutions – PPO ICING PPO application performed on proprietary software platforms  Setup customized per State for maximum penetration / savings  Network types: National / Regional / Specialty “ICING” with Fusion technology - Competitive Advantage  Increased savings through multiple network Tiers – Best in Class  Immediate network application reduces “lag time”  Increased penetration levels drive additional savings Client specific network solutions on a state-by-state basis through historical data analysis  Quarterly Reviews of PPO Penetration and Trending Analysis to ensure PPO Tier is appropriate and applicable to current outcomes 23
    24. 24. PPO ICING – Sample Listing of Network Partners National  Prime Health Services  Coventry (First Health, Focus, Aetna)  Rockport Healthcare  Healthcare Solutions  Interplan Regional  MagnaCare  HFN  Sagamore/CIGNA  Wellpoint Specialty  Physical Therapy – Universal SmartComp, Align, MedRisk  Radiology - Core Choice, One Call Medical, ADIN  Pharmacy – myMatrixx, Express Scripts, Progressive Medical, PMOA  DME – myMatrixx, TechHealth, PMSI, MSC 24
    25. 25. Incremental PPO/Specialty Savings& Penetration Breakdown PPO Savings PPO PenetrationTier 1 % of Total Savings: 29% Tier 1 PPO Bill Penetration: 21%Tier 2 % of Total Savings: 8% Tier 2 PPO Bill Penetration: 13%Tier 3 % of Total Savings: 8% Tier 3 PPO Bill Penetration: 9%Specialty Network % of Total Savings: 22% Specialty Network Penetration: 23%Specialty Review % of Total Savings: 33% Specialty Review Bill Penetration: 1%*Specialty Networks include PT, MRI, DME Total Bill Penetration: 67% Case study: National retail client with warehousing and distribution centers 2010 New Jersey Results: 75% PPO Penetration resulting in 50% Gross Savings 25
    26. 26. PPO ICING & Out of Network IRON Services PPO ICING – Identifying Incremental Network Penetration  Business Model is structured to identify and increase PPO network penetration and savings without ICS being the “primary” bill review vendor  PPO-ICING has the ability to provide additional and comprehensive layers of PPO Networks to augment and enhance existing PPO Networks, creating savings where none existed  Leveraging our proprietary technology and operational methodology, PPO-ICING can immediately identify if a medical bill “hits” a given PPO partner, assuring turnaround times are not compromised  Risk Free – ICS does not charge for processing the medical bill, only if PPO savings are achieved Out of Network Signed Agreements – IRON  Recommended referral criteria: Any medical bill that comes back without a PPO hit and over $2,500.00 in Allowance Amount should be flagged for consideration  Utilize proprietary application to identify past payment trends to establish appropriate negotiation baselines  All negotiations are tied to a signed agreement by medical provider to ensure 0% reconsiderations 26
    27. 27. Retrospective Utilization Management Augmenting the traditional Medical Bill Review adjudication process of securing savings via Contractual PPO discounts, Fee Schedule/UCR reductions, or Out of Network IRON Signed Agreements, ICS has created comprehensive Retrospective Review Programs that are typically part of our overall Integrated Medical Management Program: RN/Certified Coder review of coding and supporting documentation identifying unbundling, upcoding, and correct modifier utilization Nurses review the services for appropriateness and medical necessity RN Desk Audit focusing on a review of the itemized billing statement for medical necessity, treatment crosswalk, appropriateness of charges, length of stay, and proper documentation to support charges Automated Flagging of Services matched with integrated Treatment Plans and Pre- Certification decision points/outcomes RN/Physician Medical File Reviews 27
    28. 28. Sample Medical Bill Review Process & Procedure – Administrative Phase 28
    29. 29. Sample Medical Bill Review Process & Procedure – Decision Phase 29
    30. 30. Sample Medical Bill Review Process & Procedure – Incremental Savings & Completion Phase 30
    31. 31. PPO Network Management services managed by: 31
    32. 32. Prime Health Services History – Business Model Direct contract with providers using comparison methodology Obtain provider partnerships with “Best in Class” regional provider systems in country Acquire regional networks that fit Prime Health’s business goals Create local customizable networks where possible Innovative and proprietary technology solutions 32
    33. 33. Prime Health Philosophy of Customizing Prime Health has seen a growing lack of concern by other National PPOs to provide custom contracting for their clients. Thus, Prime Health has developed a core philosophy of giving our clients access to the providers of their choice instead of forcing them into a pre-established network. 33
    34. 34. Prime Health Philosophy of CustomizingCustomizing through Queball™ QueBall™ drives the nomination and recruitment process and is an internal operation that is unique to Prime Health. No other network offers the rapid turnaround in customizing it’s network offering to meet the needs of our clients. Review of Non-Par data on a concurrent basis 34
    35. 35. Prime Health Philosophy of Customizing 35
    36. 36. A Case Study on Customization – State of Connecticut QueBall impact on customizing and enhancing the State of Connecticut’s PPO Network include the following results:  First 90 Days post the implementation of our Network Services:  70% increase in the number of Physicians  26% increase in the number of Facilities  56% increase in the number of Hospitals  Overall impact QueBall has had on the State of Connecticut PPO network since Program Implementation  200% increase in the number of Physicians  158% increase in the number of Facilities  161% increase in the number of Hospitals Provider Counts Month Physicians Facilities Hospitals July 2009 3,751 683 18 October 2009 6,373 860 28 January 2010 7,538 999 33 June 2010 9,220 1,474 34 June 2011 11,226 1,765 47 36
    37. 37. A Case Study on Customization – State of Connecticut QueBall financial impact on customizing and enhancing the State of Connecticut’s PPO Network include the following results:  The State of Connecticut has seen their PPO Network Penetration increase nearly 63% from October 2009 (56%) to April 2011 ((91%)  Overall Network Savings below the State Fee Schedule has improved even with the larger influx of contracted providers Network Penetration – By Medical Bill Adjudicated Month October 2009 January 2010 April 2010 July 2010 October 2010 January 2011 April 2011 Total Bills 9,540 5,975 9,994 5,682 5,025 4,708 7,833 In Network Bills 5,331 4,499 8,380 5,021 4,498 3,670 7,148 PPO Penetration 56% 75% 84% 88% 90% 78% 91% Network Savings State Physician Hospital Facility CT 16% 14% 16% 37
    38. 38. Exclusive Occupational Health Network Overview Specially designed network of occupational health providers that are trained to understand and treat a work-related injury Occupational Health facilities that are in close proximity to employer locations Utilization of Occupational Health facilities that have gone through and met extensive credentialing criteria Utilization of Occupational Health facilities that have gone through and successfully met rigorous Site Visits 38
    39. 39. PBM Network Management services managed by: 39
    40. 40. Pharmacy Benefit Management Electronic Interface with Pharmacy vendor partner to establish eligibility information First Fill Process Aggressive third party paper bill conversion Directly contracted Nationwide network Comprehensive Trend Reporting Determine Correct Formularies Retrospective Drug Utilization Review Predictive Modeling Program Reduces or Eliminates “Out of Pocket” Expense Mail Order or Non-Mail Services Physician Dispensing Solutions Significant Cost Savings coupled with low implementation requirements 40
    41. 41. Pharmacy Benefit Management – Clinical ManagementOur Programs drive a lower cost per claim by managing the mix of drugs. Average Cost Per Claim/Year$2,500.00$2,000.00 Savings Per Claim/Year $2,270.75 $571.67$1,500.00 $1,699.08$1,000.00 $500.00 $- Other WC PBM myMatrixx 41
    42. 42. Pharmacy Benefit Management – Use of GenericsmyMatrixx converts 98.3% of all multisource brands to generic where it is appropriate AVG Generic Substitution 82.26% Generic Efficiency 98.3% Generic 16.04% 82.26% 17.74% Single Source Brand Multisource Brand 1.70% 42
    43. 43. Pharmacy Benefit Management – Network Penetration & Savings Results myMatrixx Claims Data vs. pre-myMatrixx Claims DataClient Type Percentage Generic Penetration Average Per Script Savings Differential SavingsAuto Clients 15.24% 8.27% $27.94Larger State 19.59% 9.85% $30.84Managed Care and TPA 18.04% 10.55% $36.95Insurance Carriers 23.09% 11.24% $39.43 43
    44. 44. Independent Medical Evaluation & Physician Review Services 44
    45. 45. IME Services – Introduction National Provider of Independent Medical Examination services Current Service footprint covers 40 states throughout the continental US Multi-disciplinary network of Board-Certified physicians Providers that maintain an active treating practice with no restrictions IME referrals via the internet Timely appointments and subsequent appointment management Timely receipt of initial and final IME reports Thorough quality assurance program to ensure client specific parameters are being met Centralized management of referral from start to finish is accomplished via proprietary Internet based application Web Portal available to access real time information, reports, and communications 45
    46. 46. IME Services Overview Multi-disciplinary network of Board-Certified physicians Providers that maintain an active treating practice with no restrictions Medical Evaluation referrals via the internet Timely appointments and subsequent appointment management Timely receipt of initial and final Medical Evaluation reports Thorough quality assurance program to ensure client specific parameters are being met Centralized management of referral from start to finish is accomplished via WebOPUS WebOPUS Browser available to access real time information, reports, and communications 46
    47. 47. IME Services –Advantages Advantages include:  Documented Return on Investment Savings  Industry Leading Service & Technology  Customized HIPAA compliant proprietary software  Real Time Online Tracking of IME Referral  Robust Document Management interface for document viewing  Complete Document Reproduction into a single source PDF using “One Click”  Link with USPS for mailing requirement compliance  Ease of Doing Business  Online Referral Sheet  Ability to refer multiple EIP for multiple specialties  Confirmation page can be easily exported to your claims system  Turnaround Time - TAT  Industry Average for TAT is 21-30 Business Days, our Average TAT is 15 Business Days  TAT from Date of Examination to Adjuster Receipt averages less than 3 Business Days 47
    48. 48. IME Services – Quality Assurance 48
    49. 49. IME Services – Ease of Doing Business Online Referral Sheet Can refer multiple claimants for multiple specialties Confirmation page can be easily downloaded (exported) to your claims system 49
    50. 50. IME Services – Online Tracking Demographic information Document viewing and/or reproduction (in PDF or DOC format) Link with USPS for proof of mailing 50
    51. 51. Independent Peer ReviewNational Reviewer Panel Over 1,100 reviewer All ABMS specialties and subspecialties Board-certified Active clinical practice Current, unrestricted state license(s) TAT to meet your business needs Dedicated customer service teams HIPAA compliant technology SAS 70 Type II certified Web referrals Re-credentialed every three years 51
    52. 52. Comprehensive MSA Services: Medicare Set Aside Medicare Legal Submission Medicare Reporting Post Settlement Fund Management 52
    53. 53. Medicare Set Aside Services Medical Services  Comprehensive overview of future care recommendations related to the compensable injuries of a claim conducted by experienced Nurse Case Managers certified in Life Care Planning  Social Security & Rated Age verification  Appropriateness of past treatment/medication use based on clinical practice guidelines and/or ODG  Compliance with treatment, response to past treatment and recommendations for future treatment  Prepare Medical Cost Projection Allocation Report  Evidenced Based Drug Utilization Review  Claim Settlement Allocation – Non Threshold MSA 53
    54. 54. Medicare Set Aside Services Legal Services  Verify claimant’s eligibility status for Social Security and Medicare Benefits  Provide professional legal opinion determining whether CMS approval is necessary and support that opinion with professional liability coverage  Provide appropriate settlement language  The assembly of a MSA Arrangement and the submission to Medicare for review and approval  Advise on method of funding and administering MSA  Provide Settlement Allocation language  Obtain quotes and arrange purchase of Structured Settlement Annuities  Medicare Lien Verification &Negotiation  Reversionary Trust & Settlement Assistance Post Settlement Compliance Services  Creating a simple all-in-one solution for administering the post settlement funds ensuring proper coordination of benefits and protection for all parties 54
    55. 55. Fraud Abatement/SIU &Medical Record Retrieval services managed by a division of 55
    56. 56. Fraud Abatement Services - Surveillance Largest provider of surveillance services in the industry National Coverage  Over 270 Employee Investigators  Dedicated experienced staff that focus exclusively on this service component Highest ethical standards Direct Management of all Files Defined Quality Control Program Ongoing Training Programs Accountability Monthly Reports Communication 56
    57. 57. Fraud Abatement Services – eSearch eSearch Investigation can cover wide ranges of inquiries, as well as a focus on specific leads or known relevant areas Common examples of available record information: Police Reports Criminal Records Suits and Judgments Bankruptcy Records Property Ownership, Motor Vehicle, Recreational Licenses Education Employment Detailed research report that can access: Various Internet Search Engines Social Networks Satellite Shots of Pertinent areas Press Releases News Articles Canvassing Activities This research can provide extensive information to facilitate focus of surveillances and other field inquires 57
    58. 58. Fraud Abatement – International Experienced provider of claim investigations in over 200 countries Established relationships with reputable network of resources in each nation Cost effective service with specific quotes for an investigation before it is handled – no surprises Management of the entire process from start to finish out of our Dallas TX office Types of reports include:  Death Related Investigations  Death Verifications  Interviews  Surveillance  Background Checks  SIU Investigations  Translation Services 58
    59. 59. SIU Services Specific SIU Division within ICS Merrill 48 Investigators with over 20 years average experience Complete national coverage by locally based investigators Proficiency in all lines of property and casualty coverage’s Full of supplemental service functions per client needs Fraud reporting to State Fraud Bureaus and State Department’s of Insurance Fraud training programs for clients Ease of communication – single point of contact service 59
    60. 60. Fraud Abatement & SIU Services - Technology SmartPartner Case Management System  Access with password through secure website  Submit work requests  Track case progress  Receive email alerts on the referral  Review actual reports  See video clips or entire video  Access to all historical data and video Digital Video Library Link  Access actual reports, documents, invoices  Electronic link may be forwarded to client for ease of access  Transfer the link to other parties within your organization  Client designates life span of the link 60
    61. 61. Medical Record Retrieval Services Parent company of ICS Merrill provides services directly– EMSI EMSI is the largest and most experienced provider of medical record retrieval services to the insurance industry EMSI has existing relationship with many Carriers for underwriting, medical records, and paramedical Average 3,700 Medical Records retrieved per month Average 12 Days to complete Service Referral 61
    62. 62. Our Technology Suite“The ICS Web Portals provide visibility into the progress of a case undermanagement for the adjuster and other stakeholders, as well as provides anentirely electronic internal workflow for addressing all service requirements of anIntegrated Medical Claim Management Program as well as creating a “Paperless”medical file as all medical documentation associated with the claim will beavailable electronically” 62
    63. 63. WebOPUS - Browser Tool Facilitates communication with real-time access to user friendly, web-based care management software Provides browsers the ability to:  Follow the medical & disability aspects of cases online  Review disability guidelines by diagnosis code  Communicate with nurse case manager online  Locate medical providers by location/specialty  Receive auto email alerts of new First Reports of Injuries & Case Management Episodes of Care  Retrieve Case Management Reports online  Review the medical payment history on a claim  Retrieve & Review medical documents attached to a claim  Generate Management Reports on demand 63
    64. 64. Adjuster Web Portal Tools eBRIDGE Adjuster Production Worklist Web Portal  Access to Pre-PPO EOR/Bill Images  Line Level Approval Denial  Customizable Denial Reasons  Free Form Text Denial Comments  Automated Throughput WebOPUS Real Time Browser Web Portal  Access to all completed historical bill data and images  Access to all completed Utilization Review records and medical documentation  Access to all Case Management information, including return to work documentation, Nurse Notes, and Treatment Plan management  Receive auto email alerts predicated on Case Event Milestones  Follow the medical & disability aspects of cases online  If applicable, ability to interact directly with assigned Nurse Case Manager, Utilization Review Nurse, and/or Hospital Bill Audit Nurse. 64
    65. 65. Case Management / Bill Review Seamless Integration Claim Data  Claims created from Client Claim Feeds  Claims created from ICS FROI Services  Claim updates received from any Third Party Source  Pre-Authorization / Pre-Cert Header & Line Detail outcomes with notes  Claim Flags created from Pre Cert and Claim Update process Pre Cert Data – Fee Schedule data creates cost and savings reports Online Bill Approval / Denial Portal – Status and Outcomes Case Management Billing Screen – Comprehensive Service History Automatic Claim Reopening & Nurse Intervention 65
    66. 66. EDI Capabilities Incoming  Claim/Eligibility  Provider/Vendor Files  e-billing  UR/CM notes/data  PPO data  Check Number/Date Outgoing  provider payment for ease of generating reimbursement checks  EOR Header and Line Detail data (including CPT codes)  review fees  PPO data  Regulatory (TX & CA EDI mandates) Systems flexibility to match and re-create existing EDI processes Transfer of files can take place using SFTP, VPN, electronic mailbox, e-mail etc. 66
    67. 67. Comprehensive Reporting Dashboard Capabilities & Sample Stewardship Report & Outcomes Standard report package designed to meet client needs Web based reports are concurrent with Real Time Data Customized Stewardship & Ad Hoc Reporting Auto Reporting Triggers Demonstrates program effectiveness State Reporting Identifies safety & loss control interventions 67
    68. 68. Implementation & Account Management Philosophy Implementation is the Key to Program success Dedicated Implementation and Operational Team Senior Level Account Management Detailed knowledge gathering round table meetings Customized service programs and reporting Ad Hoc Status Calls Monthly Program Updates Quarterly Stewardship Meetings and Efficacy Outcomes 68
    69. 69. ICS offers a Unique Partnership Comprehensive service and processing solutions Bundled or unbundled program management Customized medical processing and flexible network options Program designed to address your claims population needs Lower cost solution due to proprietary components Complete transparency with no conflict of interest Key Attributes: Integrity, Innovation, Service, Flexibility, Technology, Results 69
    70. 70. Our Vision 70