Our goal is to help provide the appropriate assistance for the worker on leave for a work-related absence or time away from work without incurring unnecessary costs. To do so, we employ a holistic approach to deliver the best care and resources possible for speedy recovery. By integrating evidence-based criteria, clinical expertise and advanced technology into the claims process, we can implement medical management cost saving services that generate better outcomes.
Broadspire’s Medical Bill Review (MBR) can help reduce unwarranted charges associated with workers compensation, general and auto liability. Our Medical Bill Review team combines expertise, advanced technology, a customized rules engine and proprietary reimbursement methodologies to reduce costs far beyond basic state-mandated reductions. Broadspire’s customers have experienced significant savings that continue to increase annually. Customers who used medical bill review in 2013 averaged a 62.3% savings from the identification of inaccurate and unwarranted charges.
Broadspire’s revolutionary BOLD PPO network has created a new strategy for superior penetration rates and savings. Instead of relying on one broad network, Broadspire has formed a carefully selected multi-dimensional, multi-tiered network to ensure we have access to the best medical professionals. By overlapping networks and adding specialty networks, BOLD provides the right coverage and the right providers to help boost productivity by returning employees to work quickly.
Our expert clinical staff of board-certified physicians and nurses reviews these cases, evaluates the biopsychosocial influences of the problem and creates a treatment plan for each individual. By applying our depth of clinical expertise, developing value-added programs with measurable outcomes and working with high quality medical partners, we customize the right solution for each employee suffering from chronic pain.
Broadspire’s case management team plays a vital role in our comprehensive medical management strategy. By creating a proactive action plan, our field, telephonic and vocational case managers can help claimants to recover as quickly as possible. By utilizing their clinical expertise, a vast database of evidence-based medical studies and the knowledge of dozens of on-staff physicians, they work with providers to avoid obstacles and find the resources needed to return to work.
PRS is a valuable resource for securing clinical expertise in claim management and medical case management. Our diverse panel of specialized, experienced physician reviewers provides well-reasoned and carefully documented determinations that evaluate the medical necessity of medical services, support timely return to work and assess the extent of functional impairment.
Combined with an effective medical bill review service and preferred provider network, Broadspire leverages a nationwide network of more than 54,000 pharmacies to obtain medication—both retail and mail order—at a significant savings beyond fee schedules and usual and customary charges. Further, our utilization management team determines whether prescribed drugs are related to the compensable injury and screens drugs for excessive or unusual dosages, premature fill requests, adverse drug-to-drug reactions and duplicate medication classes.