Our Services

Turnaround Time

We are very efficient with our bill review handling because our bill review team understands the importance of timely processing. Our average turn-around time for bill pay is 3 days, well below the industry average.

Fee Schedule Knowledge

At Diamond Bill Review, an understanding of the Fee Schedule is just a part of reviewing bills and providing proper savings. It is our attention to detail and checks and balances that allow us to deliver every cost savings measure possible, without forgoing the quality service that our customers and providers deserve. Our bill review employees are highly trained, experienced, and capable individuals that receive annual fee schedule guideline training. For out-of-state bills or bills that require negotiation, our staff is able to communicate with the providers and come to an amicable solution for all parties.

Medical Coding Knowledge

Medical coding is a mystery that seems to get more complicated each year. DBR can help ease our clients’ minds with our understanding of medical billing. Our bill reviewers have seen it all and know what to look for in all bills, to ensure proper billing procedures. Whether the provider is a Facility, ASC, Ancillary Network, individual clinic, or any other treatment center, we are trained on recognizing codes and services for authorized treatments. Our highly trained bill review staff will ensure that a bill’s DRG code matches the services the provider is billing for and will screen for the length of stay and trauma situations before applying the rates. We will identify the codes and procedures for each treatment and verify that they are accurate. Our staff is trained on medical billing and stays current with any changes that occur with the state and federal regulations.

Bill Negotiation

When a facility bill, or other billing that falls outside of the fee schedule, is received, our team establishes a U&C baseline for the treatment. We will use the 85th percentile U&C application and consult the medical treatment “Blue Book” for pricing recommendations. After establishing a starting rate for negotiation, we will contact our client to receive authorization for the recommended amount. After settling on the agreed-upon rate and receiving the negotiation agreement from the provider, DBR will generate an EOR for the specific bill and send the EOR with recommended payment allowance to our client for payment.

Performance Standards

• 3-day maximum turnaround time from the time a bill received to payment.
• Same day review-only turnaround.
• 1-day Turnaround for Complex Bill Reviews.
• 2-day Turnaround for Reconsideration Requests.
• Same Day Paper Bill Scans.
• Minimum Bill Review Processing Quantity is 300 Per Day/Employee.
• Minimum Data Verification Processing Quantity is 400 Per Day/Employee.
• Same Day Provider Request (EOR, Payment Question, Bill Process, Etc.).

Prospective Claims

On prospective claims, we can see savings of up to 40% off of the fee schedule. These providers are familiar with working with workers’ compensation claims and understand the authorization, RFA, and billing processes that are involved.

Ancillary Network

Our Ancillary Network management feature allows DBR to create a customized network that meets the needs of our clients. We can add providers that our clients are used to working with at specific pricing, so bill processing is fast and simple.

Nurse Case Management

DBR provides Nurse Case Management services that go above and beyond for our clients. Our services include:

• Field Case Management- Our nurses attend appointments with claimants to better understand treatment recommendations and answer any questions that the claimant, examiner, or doctor may have.
• Telephonic Case Management- We coordinate with the claimant, examiner and doctor over the phone to ensure the claimant is progressing and to ensure timely appointment attendance.
• Scheduling and Assistance as Needed- We assist with getting the claimant scheduled for their appointments in an efficient manner. We also answer any questions that arise and work as needed to be the resource for our clients to reach out to at any time.