“Bill Edits” is defined as scrubbing edits from CMS, AMA, or any other medical source and applied to an individual bill. 

Prime Health systematically stores and maintains up-to-date Medicare pricing methodologies, ensuring our clients have access to benchmark pricing and the capability to reprice services in alignment with nationwide Medicare rates. 

Prime Health manages a comprehensive UCR database to provide our clients with access to benchmark pricing and the ability to perform repricing according to UCR standards on a national scale. 

The Prime Health negotiations solution utilizes our very own qualified negotiations professionals who pay close attention to medical charge billing while thoughtfully and expeditiously researching and negotiating bills for appropriate level of payment. 

This solution meticulously assesses surgical implants through six essential savings and reduction modules, aiming to greatly reduce costs and offer clear insights into trends that inform medical managers. Prime’s data-driven systems improve pricing transparency and objectivity for surgical implant devices. Our comprehensive evaluations guarantee fair reimbursement, providing clients with robust assurance and support for their pricing strategy. 

The Prime FMP + methodology will be deployed based solely upon pre-established and mutually agreed to parameters, such as state, provider type, bill type, bill amount, etc. 

The methodology applied is based on annualized reimbursement data from a nationwide dataset of average and accepted reimbursements, reported cost data, historical charge reports and negotiated results for each bill. 

Prime Health efficiently maintains current State and Federal Fee Schedules within a robust database, enabling our clients to access repricing options that adhere to regulatory requirements across various states and federally mandated programs. 

Leveraging ODG’s industry-leading medical treatment and return-to-work protocols, along with an extensive drug formulary for workers’ compensation, our solutions integrate evidence-based medical literature with advanced claims data analytics. This synergy optimizes outcomes by ensuring appropriate intervention levels tailored to individual cases.