Consolidated Services Group supports our auto insurance clients in managing the medical costs and care for their policyholders. We offer a diverse mix of medical expertise and innovative technology that delivers a more efficient, disciplined claims handling process. Our clients can count on proficient, knowledgeable service for every claim, from initial filing through close.
CSG offers a highly-credentialed team of on-site medical directors, nurse case managers and utilization managers, along with a robust, multi-specialty IME and Peer Review provider network. Our expert care coordinators ensure injured parties achieve the best possible outcomes and most effective care by thoroughly reviewing medical treatment and efficiently communicating with payors, providers and injured parties. Our CHN PPO network of highly-credentialed providers is specifically skilled in diagnosing and treating automobile injuries.
CSG Services are powered by medlogix® our proprietary, web-based case management and bill review software. This seamless, end-to-end technology fully integrates all CSG services into a customizable, user-friendly platform that provides real-time access to the ongoing medical management of a claim.
Our robust, multi-specialty network of IME providers delivers objective assessments to determine the medical necessity of treatment while demonstrating fairness and respect for the injured person. Our highly-credentialed network includes over 35,000 IME providers representing all relevant medical specialties. We also offer IME service in all 50 states through our coast-to-coast network of affiliate partners.
Requested for serious injuries and catastrophic claims, Lifetime Cost Projections (LCP) provide a comprehensive evaluation of current and future treatment needs and expected medical costs associated with the treatment plan. Case management professionals perform an extensive review of the claim file and medical history and deliver a comprehensive report, along with supporting documentation.
When a face-to-face evaluation is not required or possible, our network of fully credentialed and board certified physicians can provide a retrospective review of treatment to quickly and competently determine whether care provided was medically necessary and causally related. Our panel of physicians are required to have their own functioning practice and must be willing to testify in the event of a dispute.
The end product will include:
The direct oversight of a medical professional provides valuable guidance for complex or catastrophic cases, or those that are not progressing as expected. Nationally certified registered nurses (CCM and/or CRRN) with three to five years of catastrophic case management experience assess and coordinate treatment by working with medical care providers, employers, attorneys, injured persons and their families to ensure quality health services are delivered in a cost-effective manner. The result is decreased hardship to individuals and their families/significant others as a result of their injuries and reduced financial exposure for insurers and self-insurers.
Case management is directed toward:
CSG provides a highly advanced bill review system powered by medlogix® -- our proprietary, web-based platform for managing claims information. This seamless, integrated platform provides real-time claims data 24/7 and meets all local, regional and national jurisdiction requirements. Utilizing this powerful system, CSG bill reviewers evaluate the diagnosis relationship, medically necessary treatment and properly coded billing patterns against the corresponding covered loss. medlogix® automatically scans for duplicates and matches treatment codes to actual documented treatment. The bill reviewers utilize this technology to identify improper coding or billed services that may require further scrutiny. Where appropriate, they reprice provider, facility and ancillary service bills. They also apply preferred provider adjustments or, if preferred provider discounts do not apply, refer bills for out-of-network negotiations. The result is the utmost in efficiency and savings for our customers.
medlogix® software employs the following automated analyst edits for all applicable state medical fee schedules and rules, including the following:
A CSG coding professional reviews the CPT-4 and ICD-9/ICD-10 coding of outpatient services by physician, diagnostic, therapeutic, and durable medical equipment companies to assess and resolve inappropriate billing practices. CSG's code review services are performed by a team of highly skilled registered nurses with years of coding experience. Codes requiring review can be customized based on client needs and are triggered during the bill review adjudication process to ensure provider billings are not unbundled, fragmented, up-coded, unrelated or otherwise improperly coded according to national or regional billing practices. When a provider bills with modifiers, the coding professional reviews the documentation to confirm the use of the modifier is supported, adjusting the provider bill and removing the modifier, where necessary.
Bill negotiations reduce the costs of medical bills from providers and facilities not participating with a provider network for total cost management. The negotiation team proceeds with a review of UCR, Medicare, claims utilization history and in-network payment rates to aggressively negotiate with non-network hospitals, physicians, and ancillary health care providers to reduce costs.
CSG's Bill Negotiation program includes: