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Negotiated Bill Review – Saves Big $$ With Right Provider


Negotiated Bill Review – Rarely Mentioned Risk Management Technique

The Negotiated bill review is rarely mentioned even by providers of the service.   I often phone consult with investment companies examining the Workers Comp market to see if it is a viable area of insurance.  The usual inquiring questions are what most WC insurance personnel discuss a large portion of the time.   Those would be TPA’s, bill review, PBM’s, Rehab nurses, durable medical, etc.

Picture Of Hand Presenting Negotiated Bill Review Dollar Sign

The one that in my opinion is not used often enough is negotiated bill review primarily with medium-sized and larger surgical and hospital bills.  If a TPA or carrier has a medical bill review company, there is usually a threshold where the bill is automatically reviewed for possible overcharges by the contracted bill review company.   The bills are sometimes reviewed electronically which to me is not really a great type of bill review.

How I came to this article was someone at a very large governmental agency asked me if they could ask for a second opinion on the larger bills.  There may be a conundrum due to agreements with the original bill review provider.

Dollars Negotiated Bill Review Cash

We have actually assisted in the referrals for a second opinion on the negotiated bill review.  I am not so sure that a provider would want to hear from two bill negotiators on the same bill.   We have never really run into any snags in the process other than possibly what is in the bill review contract.

Very surprisingly, there are some companies that are not even running the medium-sized and some larger bills through a network.    Relying on your TPA or carrier to confer that the larger bills are receiving a hands-on negotiated review may be costing $$.   The word automatically is not the one to hear in these cases.   Do you know at what level your bills are being reviewed hands-on and not electronically?   If not, you should check on that and see if the level is appropriate.

The appropriate level may be less than the auto-review level.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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