About CareSentry

PT & Chiropractic Claims:Do you know what your paying for?
Although a bill from a chiropractor or physical therapist may not be a high dollar amount, what happens when you begin to add up all the charges over weeks or months?

The sheer volume of these claims makes it difficult to keep track of which ones are excessive.

CareSentry provides a consistent and automated process for screening all of your chiropractic and physical therapy claims.

Our clinical algorithms are like having an onsite consultant looking at all of your bills to flag the ones that appear excessive or not medically necessary.
CareSentry will filter out the wheat from the shaft!

Claims are automatically evaluated for…

• Duration of care and number of encounters
• Level of CPT coding (up-coding)
• Medical necessity and appropriateness
• Excessive diagnostic testing
• Potentially duplicative treatments

3 Ways to get the provider charges to us…

• Electronic Data Interchange (EDI).
  This is the preferred method for high volume clients.
• Fax, Mail or Email.
  MMS will do the data entry, although there is an additional fee for this service, it’s still very cost effective.
• Enter Charges Online.
  If you prefer to do your own data entry, just go online and enter the bills into our secure web-based application.

The CareSentry Report…

• Once the provider charges are filtered through our clinical algorithms a line item report is generated.
• The report identifies all charges that appear appropriate and those that are pending.
• Pending or flagged charges have a brief rationale describing the reason the charge has been questioned.
• Totals are listed for the charges reviewed; potential overcharges and accepted charges.

The CareSentry Advantage…

The CareSentry report provides you with the distinct advantage of being able to pre-qualify claims that will yield cost savings upon peer review. You’ll see at a glance the potential savings on each bill and be able to identify a larger percentage of your claims that could yield savings based on excessive provider billing.

Sure, an adjuster can identify the most egregious claims – the outliers that stick out like a sore thumb – but what about the hundreds or thousands of claims that go undetected? One person described CareSentry as going from fishing with a single line to using a 60 foot trawler using a large net.

Additionally, by utilizing the CareSentry bill settlement negotiation services, the potential savings is two fold! Not only do you get the savings of a peer review, but at a fraction of the cost. Here’s how:

• Based on the CareSentry report, a settlement offer letter and release form is sent to the provider.
• If accepted, you receive the savings of peer review without paying for a peer review.
• The release form signed by the provider legally releases you form any further liability regarding that bill; the provider can’t appeal or sue for additional payments.
• If the offer is not accepted, the case is sent for peer review but your total costs for the settlement negotiation process and peer review is no more than your paying now for the peer review alone!

Peer Review Process Management…

CareSentry’s seamless integration of the peer review process allows for reduced process times, quicker turnaround times and that equates to savings! You save time and money.

• To order a peer review, just click a button and an electronic referral is sent to a peer review vendor.
• The medical records for the review can be faxed or attached directly to the case on the web.
• CareSentry automatically generates a peer review template, organizing all questionable charges and inputting the appropriate peer review question. No more completing referral forms and writing out what questions you want answered in the review.
• By utilizing CareSentry’s clinical logics, the peer review is focused and the report template actually reduces the time it takes to perform the review. Additionally, the “Reference Master” feature aids the reviewer in producing an evidenced based review that improves and defensibility.

The end result is more efficient and cost effective process for dealing with over-utilization.

Simply Put: Cheaper, Better, and Faster.