(520) 529-2010 shicinc@aol.com

Medical Claims Review Hotline

Complex Claims

While we review almost any type of medical claims issue, certain types of claims and claim issues are most effectively handled through HOTLINE services.  These types include, but are not limited to:

  • Unbundled surgical claims
  • Medical necessity
  • Eligibility
  • Upcoding
  • Overutilization of coding or billing
  • Fraud and/or abuse
  • Potentially cosmetic or excluded/limited by the Plan
  • Interpretation of plan document
  • Substance abuse
  • Psychological
  • Possible experimental or investigational treatments
  • Potential rescission
  • Denials and ERISA appeals
  • Other claims which require a second opinion

HOTLINE Report 

Our in-depth HOTLINE review delivers:

  • A comprehensive summary of the information submitted to us
  • An outline of the steps taken in the course of our review and the rationale behind them
  • Detailed analysis, including specific references to plan language, providing a clear explanation of our opinion and recommendations
  • A monthly status report outlining the files we’ve reviewed and the savings we’ve identified

HOTLINE Savings
HOTLINE clients have seen consistent savings of 20 – 50% on the claims submitted for review.

HOTLINE Specialist
Every claim is initially reviewed by our HOTLINE Specialist, who has proven experience in medical claims procedure, plan language interpretation, investigation, and auditing.  Further, our Specialist has technical expertise in the field.

Many of the claims we review concern plan language interpretation.  Our Specialist addresses the issue of plan language, if provided, in every HOTLINE claim report.

Focused Medical Review
Claims requiring focused medical review are referred to one of our Physician Specialists for an opinion.  Our specialties include, but are not limited to:

  • Neurology (Pain Management)
  • Cardiology
  • Dentistry
  • Endocrinology
  • Internal Medicine
  • OB/GYN
  • Ophthalmology
  • Orthognathic
  • Otolaryngology
  • Pharmacology
  • Physical Therapy
  • Podiatry,
  • Speech Pathology,
  • Psychology
  • Psychiatry