Medical Review Services

With today’s ever-rising workers’ compensation costs, it is difficult to contain costs and remain compliant without having visibility throughout the bill lifecycle. Genex’s Medical Review Services applies our clinical expertise to every bill, helping you realize the greatest returns throughout your claims management program while lowering your total cost of risk.

This Solution Helps Mitigate

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Regulatory Changes & Fines

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Lost Time & Productivity

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Control Medical Costs

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Adjuster Overload

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Siloed Data

Reduce Medical Expenses

Gain transparency into cost, quality and utilization of care

We apply our extensive clinical expertise to every bill reviewed. Our dedicated compliance staff is tenured and specialized in bill review. You receive a true idea of what you are saving through audited savings, so you always get the savings that is reported to you.

Achieve Better Outcomes

Find savings based on your unique needs

A consultative approach to developing customer-centric workflow that leverages best-in-class automated rules helps advance bill analysis so you can quickly identify and implement clinical intervention actions to improve outcomes. Customer-specific medical bill review program data is used to identify actionable ways to improve your program, including easy-to-implement services and system options. More than 500 self-insured customers rely on Genex’s Medical Bill Review Services to deliver cost savings.

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Continually identify additional savings opportunities

Our customizable, data-driven program gives you a transparent view into your cost, quality, and utilization of care. Our program finds savings based on your unique needs and continually identifies opportunities for additional cost control.

Are you missing out on bill review savings opportunities?

Learn how to assess your bill review program in our Bill Review Health Check series.

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Seamless service integration

This service can be seamlessly integrated across systems and services to provide much needed visibility and deliver analytics-driven program enhancements.

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Settlement Demand Package Reviews

When it comes time for litigation and settlement negotiations, you need a comprehensive view of the necessity of treatments and associated costs throughout the claim to give you an informed position for negotiations. You need to rely on experienced medical experts to determine causation, medical necessity, and utilization so you can responsibly negotiate from an informed position backed by a medical expert review.

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Implant Cost Containment 

Implant devices are very expensive and have a complex supply chain where suppliers often apply enormous markups to the actual purchase price. Additionally, complex state-specific regulations make it challenging to understand what is being billed by the facility and what the correct implant reimbursement should be.

Genex partners with ForeSight Surgical Implant Solutions to provide a comprehensive solution that determines appropriate implant reimbursement to provide significant savings to our customers. This program delivers objective, credible and defensible claim reductions and negotiations.

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Realize substantial reductions on medical billing

Genex's RightSize negotiation service provides substantial reductions on medical billing by analyzing the charges and medical stay against several costing data points, from which an appropriate and fair final bill can be negotiated.

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Need to reduce your total cost of risk?

To help lower your total cost of risk and return injured workers to work as quickly as possible, we offer a FREE consultation with a workers’ comp expert. Together, we will begin to build a workers' comp program to meet your company’s unique needs.