Medical Review

 

Medical Bill Audit

 

Argus provides superior medical fee guideline review services. Our system reflects an audit philosophy that recognizes the need for a distinct balance of detailed personalized review by a qualified medical professional and an accurate efficient computer system for the generation of a clear and concise product for our clients.

 

All bills for medical care are evaluated in accordance with the rules and guidelines as established by the state’s fee guidelines. Argus utilizes usual and customary data according to geographic regions for services that are not scheduled in the states medical fee guideline.

 

Argus’ hospital bill auditing services are not subcontracted. Our audit consultants and on-site hospital audit nurses are trained experienced professionals who possess state-of-the-market knowledge of medical facilities. Such expertise gives Argus a formidable advantage when reviewing a client's medical bills at large.

 

Argus will develop a consistent and reasonable payment policy for the individual client that complies nationally with each statute and tightly controls medical costs.

 

Preferred Provider Organization (PPO) Networks

 

Argus’ PPO network services are provided through our contracted relationships with established PPO networks. Additional savings below the individual state Medical Fee Guideline allowances can be realized by access to a PPO through the benefits of negotiated contracts for medical services with providers throughout the nation and have proven to increase overall savings. The savings derived through this process are savings that would otherwise not be gained.

 

With the enactment of House Bill 7 in 2005 by the Texas Legislature, Argus made a strategic business decision to form and be certified as a Health Care Network. Our application has been submitted and is being reviewed by the Texas Department of Insurance.

 

Medical Review

National Pharmacy Network

 

Argus utilizes a specialty pharmacy benefit management (PBM) company providing a comprehensive program of pharmacy services for workers' compensation. The PBM program is designed specifically to consider the unique needs of workers' compensation injured workers, employers, and payors, and we can assure our customers the most superior pharmacy benefit management program available. We have contracted with an extensive network of over 47,000 nation-wide to guarantee that injured workers are able to find a pharmacy of their choice.

 

The "passive" savings in a strong network of medical providers can be quite significant. Participating PPO providers are located in rural and small areas as well as large urban and metropolitan areas throughout the nation. Optimal savings can be achieved when all medical cost containment services are used concurrently.

 

Outpatient Surgery Bill Review

 

Argus utilizes an advanced bill re-pricing service to significantly reduce the facility fees charged for outpatient surgery services. These fees are not always covered by state fee schedules or PPO’s and may normally be paid in full or with minimally negotiated discounts. Argus delivers an average reduction of 65 to 75% on these bills.