Claims Management / Protocol

Comprehensive Risk Management takes a proactive approach to claims management. This approach results in effective cost containment by achieving appropriate claim resolution in the shortest time possible.

Medical Cost Containment

There are really two levels to effective medical cost containment. The first level includes scrutiny by the claims administrator to ensure that services are reasonable and necessary and in compliance with the State's Medical Aid rules. After medical billings have been approved, the second level of review occurs in our bill adjusting department. Like most third-party administrators, we offer computerized bill adjusting services. These programs can save an employer 18 to 20% over billed amounts in many cases. However, we go one step further. Our bill adjusting staff manually compares the code billed with the services provided. This additional step has resulted in exceptional medical cost containment for our clients. For example, we have several clients who have experienced savings in excess of 30% over original billings.