Prizm, Medical Bill Review Specialist

Prizm has provided medical management and medical bill review services to the auto, property and casualty markets. Our technology and services provide our clients with an accurate, detailed, and defendable tool to improve outcomes and protect reserves. Nationwide 1st Party Bill Review-Utilizing our comprehensive claims web base management program, Nextrum, bills are keyed and run through our claims system. Demand Package Review Program-This is an in depth audit of the paid and unpaid medicals of a demand package. We provide a framework, where adjusters can send us the medical specials and we will review for accuracy. The charges can be reviewed and audited based on PIP Fee Schedule, Usual & Customary, and Medicare. New Jersey AICRA (PIP Program) –Prizm has a certified Decision Point Review (DPR) filed with the New Jersey Department of Insurance & Banking. Since 2001, we have been providing a robust medical program to Auto Carriers within the state of New Jersey. Our in house staff of trained professionals and nurses ensure compliance with care plans and an extensive PAR panel to review ongoing care. New York PIP Arbitration Support-Prizm can provide a PIP department’s arbitration assistance. We provide a certificate of conformity to comply with New York Regulations. Our Certified Professional Coders (CPC) can evaluate the medical bill and records based on New York Fee Schedule. Our experts are available for litigation purposes.SIU Validation Services-SIU teams that are performing enhanced medical investigations, can rely on Prizm to assist in validating their internal results. Our experts are available for litigation purposes.