Access sonar:

• sonar

    Access eQRIS:

• eQRIS

We ensure maximum savings through:

•  Combining National Coverage Capabilities, for all lines of business. Application of fee schedule and billing ground rules, as set forth by the state. Our state of the art software is the premier vendor of reimbursement schedules in the market, ensuring compliance by updating our system with the state regulations and fees on a 30-day cycle.

•  Usage of an "U&C" (Usual and Customary) Database, in states where no fee schedule exists, our system contains modules for Medical, Dental, Outpatient facilities, Inpatient facilities, Anesthesia and Medicare's RBRVS Physician Fee Schedule. The percentile of reimbursement is customized to our clients' specifications or the industry standard. This highly respected system entails more than 700 million current, unique and continuously updated provider charge records, with 1,500 private-sector health care companies.

•  Application of the AMA (American Medical Association), NCCI (National Correct Coding Initiative), and national coding parameters and managed care benchmarks.

•  Detection of Improper Billing Practice, such as up coding, code "unbundling", undocumented charges and billing for incidental procedures. A complex CPT and ICD-9 collision, which guarantees providers bill only for claims within the scope of the related accident.

•  Dupliciate Detection on the claim, line and bill level not only for "true duplicates" but also concurrent care is implemented.

•  Integration of all utilization review decisions into the bill review process to disallow charges for medically unnecessary or unrelated services. Integration with our Managed Care Module (QRIS) to ensure only reimbursement is made for items approved in the treatment plan, and auto-adjudication of pre-authorization records. Integration with Claims Systems allowing our client's system to "talk" via technology to our system, allowing us to disallow charges at the Claim's Examiners request. Our system has the ability to interface with external claims systems-often without IT assistance.

•  Preferred Provider Organizations (PPO), Procura Management Inc. has networks comprised of not only national, but also regional and local networks. Additional savings and the quality care that our clients demand and deserve is realized through this carefully tailored offering.

•  Through the PROCURA PREMIER PROGRAM, we are able to achieve savings as a team of skilled negotiators to secure reductions for out of network review bills. To even further maximize savings, we provide line item review by a C.P.C., nurses and other coding specialists.

•  With over 70 CUSTOM REPORTS, Procura Management Inc. has the ability to track everything from treatment benchmarking to our client's ROI. Procura Management Inc. also reports to the states where mandated on behalf of our clients. Seamless outcome reporting will give you reports on all aspects of Cost Containment business.