Marquee’s expert bill review services bring value to our clients because we are able to provide transactional speed and accuracy, improved operations, productivity, compliance and medical and administrative savings with our customized bill review system.
Our tailored software is customizable to provide ultimate flexibility for our client-driven rules and fee schedule rules.
Another way we’re meeting our clients’ needs – A bill review system that is customized to their needs.
Helping injured workers return to work while managing the costs for our clients has become our specialty.
An automated online referral process ensures our dedicated preferred vendors are used. Our online processes include:
Dr. David Ingrum
Marquee Managed Care Solutions offers proven solutions to medical cost containment while highlighting customized strategies for our clients.
We have highly skilled licensed nurse clinicians who deliver timely treatment decisions with the most updated online California State/Regulatory Guidelines available at their fingertips. We offer full service Utilization Review which is fully integrated with our bill review application. We offer the following state certified services:
We offer quality clinical opinions on medications whether there is a concern for abusive prescribing patterns or the focus is on high dollar spend with opioid usage. We have an on-staff pharmacy doctor, as well as medical doctors specializing in pain management for review of medical records, drug utilization review, and narcotic control program. All these programs have a focus on improved clinical outcome and financial benefit to the claim. The narcotic program was developed to address inappropriate opiate use and to develop alternatives for the injured employee, while staying within the confines of treatment related to the claim.
Our team of registered nurses is highly experienced and educated in case management for the California Worker\’s Compensation market as well as other state jurisdictions with medical management and discharge planning coordination. Their mission is to oversee care by directing the claim to affect positive outcomes for the injured employee as well as the employer. Registered nurses apply appropriate state mandated guidelines in conjunction with extensive medical experience to move the claim along, avoiding missed opportunities to capture savings. Through early entry management of a claim, our nurses can drive medical care and provide predictive modeling for who are likely candidates to return to work.
Recognizing the value of face to face contact with catastrophically injured employees can go a long way in providing that caring touch which may resonate with benefits to the claim, such as enhancing return to work. We partner with the best national vendors to deliver this service.
When requested treatment falls outside state guidelines, the utilization review nurse send the case to our physician advisors for peer review. Our Medical Director, Dr. Ingrum will match treatment requests to the best physician for the case and follow evidence based medicine and State Guidelines in applying a peer decision. If the case needs clarification, our nurses will facilitate communication with appropriate parties (requesting physician, claims adjuster, or the clinical nurse manager).
Our physicians go a step further and will offer their services to look at the claim, provide physician advisory reviews which help the claims examiner to determine disability management issues, such as compensability, return to work, and narcotic opioid management. The overall benefit is to focus on moving the claim along to return to work and reducing costs along the way.
With more than 90 years of combined industry experience, the Negotiations & Resolution Unit (NRU) has vast and varied knowledge that lends to a versatile, comprehensive approach and unrivaled strategies for tough lien resolution. Our industry-wide recognition and relationships facilitate the best settlements for our clients. We have a proven track record showing greater medical cost savings and lower defense costs on NRU files.
Averaging savings in excess of 49% below fee schedule, our expert team of designated negotiators maximizes its efforts via telephonic services for more immediate results. Each negotiator has a solid reputation within the industry that drives further success and achieves more equitable settlements. Our fees are outcome based, which result in a greater incentive for overall program savings.
This service was specifically designed to assist clients when medical services are obtained outside of a customized savings network. Our experts focus on minimizing the high dollar out-of-network hospital bills, rehabilitation admissions (pre-admission or post-discharge) and reducing allowances on fee schedule exclusions such as dental, transportation and interpreting bills. Our negotiation services are not limited to the above as we are always working to assist our clients in achieving the most optimal savings possible in order to reduce potential loss costs.
With more than 90 years of combined industry expertise and knowledge, our team of experts specializes in lien hearings/trials, walk-through settlements and provides thorough cost benefit analysis (ROI) of litigation vs. settlement to provide maximum savings. NRU hearing representative services, combined with our competitive and flexible program pricing options, allow for immediate and significant savings results unmatched by traditional claims adjusters or law firms.
NRU provides experienced and knowledgeable expert witnesses who will demonstrate creative defense strategies proven to be successful. Our expert witnesses assist clients in coordinating tactics with defense counsel in order to achieve desired results. NRU expert bill review witnesses are available at competitive rates.
Extensive research completed prior to any settlement negotiation helps uncover loopholes, which helps prepare a solid defense strategy. This is also when we determine if bringing in an industry expert would benefit the negotiation.
Fees for negotiation services are based on results achieved, which ensure our clients receive maximum savings.
We work closely with a Special Investigations Unit (SIU) to uncover and report suspected fraudulent or abusive activity on the part of the lien claimants.