Clients requiring a broader spectrum of customized payment integrity solutions utilize Equian’s Bill Review services. Equian Bill Review services are customized solutions for our specialized markets and include the following service options:

Bill Audit
Bill Audit includes reviews for appropriateness, integrity and validity such as correct coding, medical necessity, usual and customary charge review, pre-existing condition analysis, coordination of benefits/third party liability and recovery, repatriation considerations, and coordinated review with client’s in-house medical review or contracted medical case review.

Medical Case Review
Equian employs contracted physicians and registered nurses to consult with clients regarding the effectiveness of a covered person’s treatment. Our network of board-certified physicians and registered nurses provides consultation and support related to implementing cutting edge cost containment and quality management strategies currently being used within the health care industry. Medical management services include prospective, concurrent and retrospective review, pre-certification, emergency room review, and utilization management reporting.

Negotiation
After a claim has been case reviewed and audited, Equian staff utilize all of the data to renegotiate the claim based on the audit and case review findings.

Equian has been providing the very finest in managed care services for the Maritime industry for over a decade. We have established ourselves as a national leader in superior payment integrity and medical management services. Our ideas are innovative, our solutions are results oriented, and our procedures are technologically superior. We never forget for a moment that the customer has a choice.

What Makes Us Different?

• Customer Focused Company
• Dedicated Regional Account Managers
• Ability to Cater to Multiple Workflow Expectations
• Dedicated Quality Assurance Professionals

Repricing is the recalculation of billed medical charges based on the rates and rules a PPO has negotiated through its provider agreements. Equian Maritime manages the complexities of administration and data maintenance with over 40 PPO networks and connected payers throughout the world. Equian partners with claims payers to relieve the administrative burden inherent with repricing management through the following services:

Primary Network Services
Equian provides “single source access” to over 40 of the USA’s leading primary PPO networks. In addition to network access for medical services, Equian provides access to a selection of specialty networks designed to deliver savings for specific services such as lab, dental, DME, and other healthcare services.

Negotiation Services
For charges that are not repriced through a network, Equian offers services to negotiate a discounted price on a payer’s behalf after the service has been rendered. Negotiation is the last step in the process of driving overall savings and every effort is made to achieve the best possible savings for the client. Our motto is “NO SAVINGS, NO FEE!”

Equian offers appointment scheduling services for Maritime clients, including Cruise Lines and Vessel Owners. The primary function of this administrative service is to secure the next available appointment within the requested specialty for the injured crewmember. Our appointment scheduling specialists can arrange specialty visits in the majority of US ports. The scheduling specialist is careful to observe any directions given by the medical service provider(s) and also coordinates with the vessel captains, ship managers, and port agents.