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Bill Review / Service Bureau Printer Friendly

PPO Bill Review and Repricing
Tailored solutions with the Power of AnthemSM

Anthem Workers’ Compensation (AWC) offers PPO network solutions for Workers’ Compensation clients in our growing service area. AWC programs and services give clients (self-insured employers, insurance carriers, TPAs and resellers) the power to better manage Workers’ Compensation costs and benefits.

AWC provides PPO Bill Review and Repricing services to help ensure accurate claim administration. The services are tailored to meet the needs of clients with single or multi-state locations.

Our Philosophy

Anthem Workers’ Compensation is committed to providing streamlined bill repricing and network solutions for the benefit of our client groups.

AWC Bill Review and Repricing Options

Anthem Workers’ Compensation offers two options to meet our client’s budgetary and operational objectives:

1.  Bill Review and PPO pricing services.
2.  Electronic interface for PPO repricing with multiple bill review software systems.

Bill Review/PPO Pricing Services
  • Scanned or paper bills accepted.
  • State-of-the-art software enables pricing to all state fee schedules or U&C database.
  • Ability to negotiate non-network/non-fee schedule provider bills.
  • Electronic submission of EORs and processed bills to customer claim systems via secured FTP process.
Electronic PPO Repricing
  • Customer completes initial pricing to state fee schedule or U&C database and submits bill for PPO pricing.
  • All bills go to Anthem Workers' Compensation to maximize PPO penetration.
  • Supports fully secure, encrypted ANSI Standard 837-file submission.
  • Allows pre- and post-edits to ensure a clean bill the first time. No lost or pended bills.
  • Includes application of any "lesser of" PPO and fee schedule language per provider contracts.
  • Supports request for re-evaluation when PPO rate is at issue.

For more information regarding Anthem Workers’ Compensation PPO Bill Review and Repricing services, please call 877.232.8440, or visit our website at www.anthemwc.com.

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Anthem Workers’ CompensationSM (Anthem) is a product of Anthem Workers’ CompensationSM, LLC., a Limited Liability Corporation. Anthem accesses independently contracted provider networks through affiliated and other companies, which it makes available by contract to payors of workers’ compensation benefits. Anthem has no control or right of control over the professional, medical judgment of independently contracted providers, and is not liable for any acts or failures to act, by independently contracted providers. Anthem is not an insurance company and has no liability for benefits under benefit plans offered or administered by employers or other payors. Anthem Workers’ CompensationSM is a service mark of Anthem Workers’ Compensation, LLC. Any reference in the material to other organizations or companies, including their Internet sites, is not an endorsement or warranty of the services, information or products provided by those organizations or companies.