New Program to Protect Medical Claim Portfolios
Wednesday, February 5, 2020 | 194 | 0
February 5, 2020 - First Investigation Services (FirstI), a leader in medical provider and billing investigations, has announced a new program called SHIELDTM designed to proactively protect medical claim portfolios. By using proprietary (patent pending) data analytics, SHIELD goes far beyond the customary California Department of Industrial Relations (DIR) listings of suspended and stayed medical providers. SHIELD is driven by HEATTM software, and when integrated with a medical portfolio database, it has unique identifiers that will recognize providers that are indicted, criminally charged, suspended, or have controlling interests other entities.
According to Wil Kiesel, Director of Business Development and Account Management, "Our SHIELD+HEATTM software solution is so effective it can also detect providers that have already been criminally charged, before the DIR declaration. By applying our SHIELD solution in any bill review, MPN, or lien program, our clients avoid paying providers needlessly while also strengthening their position for both negotiations and litigation."
"The results speak for themselves," according to Beth Howard Stalker, CEO of CostFirst, a lien resolution and bill review company. "In 2019 we've found in our lien program results that the DIR list only accounted for 129 suspended and stayed providers vetted in our CUBE system. Our SHIELD+HEAT solution identified 1,227 non-qualified providers, nearly ten times as many. The real benefits for our clients come in the gross savings on liens--$1,817,876.20 from the DIR list and $9,180,177.92 based on our SHIELD+HEAT solution. We look forward in applying this program in bill review platforms for employers. It will not only yield in tremendous savings on medical claims but will also minimize risks in liability."
Michael E. Lents, COO of CostFirst, has stated that his team has applied the SHIELD+HEAT program into their litigation and has prevailed on numerous occasions proving that a suspended provider was an officer of an entity attempting to collect on its liens. The judges found that although the entity was not on the DIR list, it should be on stay pursuant to Labor Code section 4615. In fact, one case was upheld by the Appeals Board.
About FirstI - An experienced team that brings together expertise in medical provider and billing investigations to ensure compliance and uncover abuse. Multifaceted investigative services align FirstI with law enforcement, government agencies, insurance carriers and employers.
For more information, contact:
Wil Kiesel, Director of Business Development and Account Management