Retrospective Review

Our comprehensive bill review to determine medical necessity of procedures, admissions, and services not certified which occur prior to, or during the occurrence.

 

 

Bill Review & Nurse Audit

Our comprehensive review to evaluate your billing, including:

  • OMFS Adjustments
  • Duplicate Bill Verification
  • Reconsideration Management
  • Client Portal Access
  • State Reporting
  • Non-Fee Schedule Bill Repricing
  • Direct Pay Bill Management
  • eBill Compliance and Management
 

 

Utilization Review/
Pre-Authorization

TRS Utilization Review (UR) service delivers appropriate, clinically sound treatment recommendations that result in more rapid recoveries and cost effective outcomes.

  • Prospective Concurrent, and Retrospective Reviews
  • Pharmacy / Drug Utilization Reviews
  • National capabilities with licensures in appropriate jurisdictions
  • Evidenced-based national guidelines or state specific guidelines
  • National panel of credentialed, board-certified physicians
  • Peer reviews conducted by physicians of the same specialty
  • Single digit appeal rates in every state - significantly lower than industry averages
  • UR-Bill Reviews system integration with adjuster treatment alerts

Trinity helps you understand the value you’re getting, including:

  • Cost savings reports on denied / modified services - hard savings only
  • Compliance metrics by state measuring Utilization Review turnaround time
 

 

Early Compensability Assessment

A certified Trinity Doctor evaluates the first 7-10 days of medical information to determine compensability.

 

 

Impairment Rating Review

Trinity Review Physician Advisors review impairment ratings for appropriateness based on the diagnosis, and compliance with national guidelines.

 

 

Injury Severity Scoring

A Trinity Review Panel Doctor will evaluate whether Mild, Moderate or Severe determinations fall within the ISS scoring formulary. 

 

 

Peer Review

Provides an independent and objective analysis by a practicing peer physician or medical provider, when the level or type of care is questioned.

 

 

Life Care Planning

Trinty Review, specially licensed as Life Care Practitioners, develops economic forecasts of medical needs. Life Care Plans periodically assess care, set reserves, and determine the most cost effective, medically necessary services based on life expectancy.

 

 

Additional Services

DWC 32 with Claims File Analysis, IRR Reviews, Cumulative Impact Analysis, Medicare Set-Asides, Drug Utilization Review, and ODG Review