Since 2001, we have been providing New Jersey insurance carriers with the solutions needed to stay in compliance with the Automobile Insurance Cost Reduction Act of 1998 (AICRA). Our vast experience in the New Jersey auto insurance market allows us to help control insurer costs and increase claim efficiency.
For insurance carriers looking for a more dynamic approach, we offer a comprehensive DPR/Pre-Certification program for New Jersey treating providers to submit treatment plans for review. This program is offered to insurers in conjunction with AIS Medical Bill Review services or can be provided as a stand-alone service automating the delivery of information to an insurer’s processing of auto injury claims applications.
AIS reviews APTPs with appropriate recommendation based on medical protocols by a Nurse to Physician Advisor for a determination
Our nurses and physicians oversee every claim through all decision point intervals of the care path
APTP decisions seamlessly integrate with our bill review technology delivering streamlined adjudication and accurate reimbursement recommendations
Your personal Nurse Case Manager will oversee the entire DPR process from start to finish
Offered as an add-on to our DRP/Pre-Certification services, the Prospective Case Management approach proactively manages the case from beginning to end, by employing direct contact with all parties at the point of referral and at regular intervals throughout the life of the claim.
We provide both initial and ongoing contact with all parties involved at 30-day intervals
A team of best-in-class physicians will assess the necessity of ongoing medical care and are available for testimony
Nurse Case Managers determine course of treatment and conduct discharge-planning assessments with the treating provider
We’ll assess the need for submitting the claim, specifically when circumstances indicate fraudulent activity may be occurring
Our proprietary MedFlow Technology is the backbone of all our New Jersey services. Not only does it allow visibility into the life of the claim, but its electronic internal workflow provides easy access and organization of claim data and medical documentation.
Real-time web access lets adjusters view case progress and claims documents as needed
Each event is tracked within the technology, providing an audit trail to support compliance with regulatory timeframes
An electronic workflow organizes everything from requests to reviews, and all medical documentation associated with the claim
When it comes to claims processing, there are many moving parts. Our Document Management service lets you move away from a chaotic and antiquated paper- burdened system so you can organize and handle claims with greater efficiency and control.
Intake and organize all document types from receipt to the final product using state-of-the-art scanning technology
Information is collected through bill and document data capture and visual verification
Call out service assists in obtaining missing information without adjuster intervention
Auto routing of claims documents decreases processing time and expense
Entire workflow is visible and searchable at all times
MedFlow technology seamlessly integrates data and images with your current claims system
Our advanced MedFlow Bill Review Technology seamlessly advances claims data through a series of decision engines producing consistent and accurate results. And in times of intense workloads, we help you meet your turnaround requirements and keep expenses to a minimum.
Adjusters have the convenience of online access to medical bills, records and explanation of reviews in real-time with our <strong>MedFlow Adjuster Desktop</strong>.
Business logic is automatically applied to processed claims to improve efficiency and focus claims associates’ attention on critical decision making
Automated flags drive work requiring more specialized review
Our tools apply New Jersey fee schedule as appropriate to help determine recommended reimbursement
In cases that require specialized review, files are electronically routed to the appropriate professional, to help you better understand your claims and lower your risk of errors.
With the number of injury codes dramatically increasing, our certified professional coders will review the appropriateness of the billed procedures based on applicable AMA, CMS and state regulatory guidelines
Independent physicians are board-certified, credentialed, and will be matched for specialty. Review services include:
AIS staff nurses will help insurance professionals understand reported crash injuries and treatment
Services, procedures, and medications administered and billed appropriately
Highly skilled negotiators help reduce out-of-network healthcare expenses
We’re here to answer billing inquiries, investigate issues, and support insurers in resolving disputes
All explanation of reimbursement, claim forms and correspondence can be printed and mailed to providers, claimants, and their representatives
Our customer service team is on-hand 24/7 to service inquiries in a timely and accurate manner
We offer a national network of PPOs with direct, auto insurance-specific contracts. Clients can design unique network configurations for each state including:
Submit a New Jersey casualty solution request today.