In-House Bill Review

•  Has access to the adjuster notes to ensure that only the work-related part of the bill is paid.

Complete Cost Containment

•  Field Case Management
•  Utilization Review (Prospective, Concurrent, & Retrospective)
•  Pharmacy Network
•  Peer Reviews

Paperless Technology

•  Allows tracking of every document we receive.
•  Keeps documents in a secured location.
•  Allows claims department access to the file at any time.

Pharmacy Benefit Management (PBM)

•  Early identification of risk using predictive modeling.
•  Targeted intervention with prescribing physicians.
•  Solutions based on “doing the right thing” for the client and the injured worker.
•  Automated alerts for adverse trends: excessive use, inappropriate use, and cost.
•  Constant communication and education with claims handlers, injured worker, and prescribing physician.

The complexity of a claim, along with its surrounding circumstances, can indicate the need for case management. Hei services offer:

•  Contracts with multiple organizations, allowing for the highest quality nurses in each service area.
•  Competitive rates and pricing.
•  Coordination with the adjuster to match case files to the best vendor.