PROTOLYTIC UR EXPRESS

medical insurance case and utilization review and insurance claims adjustment services for healthcare purchasers and payors and providers and Medicare beneficiaries

Software-as-a-service (SAAS) services featuring software for making an automated utilization review determination by providing analysis using proprietary state guidelines, information from evidence-based medicine and other algorithms and rules; software-as-a-service (SAAS) services featuring software for use as an automated application used to obtain and enter medical requests, namely, requests for authorization received by insurance companies and employers in the claims management process, to keep track of all request for authorization deadlines, timeframes, follow up requirements and compliance with state laws, and to prevent penalties, fines and automatic approval, to provide analysis using proprietary state guidelines, information from evidence-based medicine and other algorithms and rules on the diagnosis, medical services, medications, and equipment requests based on the diagnosis, consider treatment options, past treatments completed and other factors, to speed up the review process and provide documentation for medical decisions, to keep track of new requests, additional information requests made to medical providers involved with a request for authorization, when information is received, new filing deadlines, and other actions taken; software-as-a-service (SAAS) services featuring software for use as an automated application to review the state of jurisdiction for medical requests, namely, requests for authorization received by insurance companies and employers in the claims management process and determine when peer-review is required, and automatically send required letters to the reviewer, patient, attorney, insurance adjuster, and any other parties as required by state law, and to keep track of changing response filing deadlines affected by the peer-review process to comply with state laws; software-as-a-service (SAAS) services featuring software for use as an automated application used to determine whether final determination letters must be sent to the requesting physician, patient, patient's attorney, claims adjuster, and any other party as required by state law, to confirm that all the legal requirements have been met, and to calculate the complex billing once request for proposal reviews have been completed, and to maintain records of all documents sent with attachments, all processes performed, and review peer-review billing rates; software-as-a-service (SAAS) services featuring software for use as an automated application used to interface with medical insurance claims and bill-review systems, to update claims, to flag bill review systems with final determinations, and update claims regarding denials and payment status