Medical Cost Containment

Our experienced staff and efficient processes deliver significant savings.

Bill Review

Eagle Claims partners with Genex to perform a rigorous bill review process that combines the latest technology with staff expertise to ensure prompt payments, with significant savings to our clients. Genex’s trained staff and state of the art bill review process will identify coding errors, treatment not related to the injury, unbundling, duplicates and up-coding. Eagle has consistently saved clients over 50% from what was billed versus what is paid by the client. Eagle can generate very detailed quarterly savings reports for clients.

Additional Medical Cost Containment Information

  • Our aggressive cost containment efforts have reduced bills by well over 50% in the last year.
  • All bills are carefully evaluated by an our experienced team of claims professionals to determine whether:
    • Medical services and procedures are documented properly
    • The service is work-related
  • When these criteria are met, we input the bill and apply the state fee schedule, at no additional charge.
  • All bills are automatically reviewed to determine if a PPO discount is available – which would allow reimbursement at less than the state fee schedule.
  • Eagle Claims Management clients also have access to Cypress Care– which helps to control prescription costs.
  • With larger, complex medical bills, Eagle Claims Management partners with Genex for professional review.

PPO Network Re-pricing

Each bill is reviewed to determine if a PPO discount is available, and if so that discount is automatically applied. Our PPO networks include hospitals, physicians, occupational clinics, and a pharmacy benefit manager. Providers are screened for quality of service, price, and access to the client. Use of these networks results in savings beyond the state fee schedule.

Independent

When Eagle Claims refers a claim to a nurse case manager, IME doctor, or other medical management specialist, it is done based on what is best for the client. While some other TPA’s are required to refer to their own subsidiary companies, who then in turn bill the client. Eagle Claims believes that using the best independent firms is a better solution for our clients.