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Utilization Review

 

Based on reliable science, Novare improves outcomes for the injured worker and lowers costs for the employer, while promoting an environment conducive to the well-being of the injured worker.

 

  • Pre-Certification/Pre-Authorization

  • Retrospective Review

  • Physician Peer Review

  • Impairment rating review

  • Drug Utilization Review

  • Early Compensability Analysis

  • Independent Medical Exams

     

     

     

Medical Bill Review

In order to minimize medical exposure and lower medical costs for the life of a claim file, Novare utilizes automated bill review software and other solutions which ensure maximum reductions for authorized payments on provider 
services.

 

  • Workers Compensation State Fee Schedule and U&C Reductions

  • Negotiated agreements / Pre & Post Negotiation

  • Specialty Bill Review: Rehabilitation, Hospitalization LT, limb prosthetics, High Dollar DME, Long Term Care

  • PPO, Specialty Networks

  • Liability cost analysis reviews

     

     

     

     

     

     

     

     

     

SERVICES

Case Management

 

Based on reliable science, Novare improves outcomes for the injured worker and lowers costs for the employer, while promoting an environment conducive to the well-being of the injured worker.

 

  • Medical Field Case Management

  • Telephonic Case Management

  • Vocational Case Management

  • Medical cost Projections

     

     

     

     

     

     

     

     

     

​Medicare Secondary Payer Settlement Solutions

 

Novare ensures that clients comply with The Centers for Medicare and Medicaid Services (CMS) guidelines. MSAs are the vehicles designated by CMS to be used when settling claims as a “safe harbor” that demonstrates Medicare’s interest was taken in to account in the settlement process. Pursuant to 42 U.S.C. §1395y(b)(2) and § 1862(b)(2)(A)(ii) of the Social Security Act, Medicare is precluded from paying for a beneficiary’s medical expenses when payment has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance. Novare assists in your MSA efforts by providing the following services:

 

  • Worker's Compensation Medicare Set-Aside

  • Submission of MSA to CMS

  • Conditional Payment/Lien Resolution Services

  • Social Security Verification/ Medicare Status

  • Liability Medicare Set-Aside

  • Medicare Secondary Payer Reporting Solutions

  • Drug Utilization Review

  • Medical Cost Projections

  • Life Care Plans

     

     

     

     

     

     

     

     

     

Please allow our experienced, professional staff to assist you with any additional questions you may have regarding our diversified service offerings.

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