MEDICAL BILL REVIEW
Bill Review, Optimized for You
Enlyte's cutting-edge medical bill review solution uses advanced technology to optimize bill processing for claims organizations. Employing the latest fee schedules and benchmarks, our medical bill review software ensures precise claims management. Seamlessly integrated with Enlyte's pharmacy and clinical software, our system enhances accuracy and provides a comprehensive view, enabling efficient and transparent claims management.
“Enlyte’s tools automated several bill review related processes allowing our adjusters to focus their attention on end results and the judgement that needs to be applied, rather than spend too much time doing administrative work.”
—Casualty VP, National Insurance Carrier
WHAT MAKES US DIFFERENTIndustry-Leading Bill Review Software & Services
From intelligent workflows expertly customized to your business, to integrated solutions; our bill review platform can help you accurately adjudicate claims, increase operational efficiency and contain costs.
Best-In-Class Technology & Expertise
Contain costs and spend more focused time on high-value tasks
Deep Systems Integration
Accelerate medical bill ingestion and processing
Timely Fee Schedule Releases
Maintain regulatory compliance
Highly Configurable Workflow Rules Engine
Increase claim processing efficiency and improve bill review accuracy
Automation and Straight-Through Processing
Increase automation through powerful, intelligent business rules and machine learning
SmartAdvisor
SmartAdvisor is a leading medical bill review software designed for efficient cost containment. This automated, customizable platform uses advanced technology to ensure accurate, timely fee schedule information, integrating seamlessly with claims management systems, PPOs, specialty networks, and e-billing solutions. SmartAdvisor helps organizations accurately evaluate medical charges, stay compliant with regulations, and achieve significant savings. Most importantly, it optimizes the claims adjudication process to ensure the best outcomes for injured employees. SmartAdvisor is essential for enhancing operational efficiency and maximizing cost savings.
DecisionPoint
The DecisionPoint software suite is expertly crafted for auto casualty insurance carriers and third-party administrators, offering a flexible solution for bill review requirements. Our comprehensive suite of integrated solutions enhances DecisionPoint's capability to streamline the claims management workflow, ensuring medical bills are repriced accurately and fairly. This leads to cost containment, improved consistency and boosted operational efficiency. Ideal for optimizing claims processing, DecisionPoint ensures a smoother, more efficient management of auto insurance claims, enhancing accuracy and fairness in medical billing.
Cost Containment Solutions
Workers' Compensation
Bill Audit
Our AuditPro bill auditing solution employs a unique blend of technology, data and expertise to detect billing errors, validate and correct medical codes and charges against medical records for bill review pricing. The AuditPro solution addresses a wide range of bill types including professional and facility bills.
Workers' Compensation
Specialty Bill Review
Enlyte’s FairPay Flex solution provides proven and substantiated usual and customary pricing to help our customers consistently pay out-of-network medical bills when fee schedule pricing is exempt. FairPay Flex is supported by a team of experienced bill reviewers, nurses, legal and compliance experts.
Auto Casualty
New Jersey Integrated Bill Review
Enlyte’s New Jersey Decision Point Review+ (NJ DPR+) is the only fully integrated, comprehensive solution for national support of your bill review workflows in New Jersey. With all aspects of claims managed in-house, our solution allows you to receive full claim support, removing the need to separately contract with third parties for the portions of the workflow currently outsourced.
Auto Casualty & workers' Compensation
Negotiations Services
Enlyte's direct-to-provider negotiation services help secure discounted rates on medical bills using a variety of strategies including prompt-pay, data-enhanced and strategic negotiations. Our negotiation services can be utilized across workers' compensation and auto claims.
Auto Casualty & workers' Compensation
ePay
Enlyte’s ePay solution streamlines the medical payment process by replacing inefficient paper-based methods with secure electronic payments. Integrated within the bill review workflow, ePay helps expedite payment cycles, reduce costs, and allows providers to choose their preferred payment method.
Auto Casualty & workers' Compensation
eBill
Enlyte’s eBill solution streamlines the electronic medical billing process between providers and payers to reduce operating costs and improve claims efficiency. Integrated with Enlyte’s suite of casualty solutions, eBill ensures compliance with state reporting requirements and accelerates billing and payment turnaround times.
Guidewire + Enlyte
The Cloud-Native Accelerator is a pre-built integration that connects Guidewire ClaimCenter with Enlyte’s SmartAdvisor and DecisionPoint platforms, enabling near real-time data exchange, straight-through payment processing, and configurable auto-approval rules. Built by experts at Guidewire, this cloud-native solution simplifies implementation for faster deployment and greater accuracy in medical bill processing for Workers’ Compensation and Auto Casualty claims. By unifying disparate systems and keeping claims and bill data current, the Accelerator shortens claim cycles, tightens financial controls, and reduces maintenance costs to maximize your return on investment.
DELIVERY MODELFlexible, Scalable Solutions to Fit Your Needs
Enlyte offers its medical bill review solution in the way that works best for you, offering three flexible options:
Software License
Your internal teams use DecisionPoint or SmartAdvisor.
Hybrid Model
You retain control of portions of the bill review operations while outsourcing others to Enlyte.
Business Process Outsourcing
Enlyte manages your medical bill review operations on your behalf.
Our Technology Enabled Services handles your necessary, but often expensive internal operational tasks so you can shift focus to your business’ core competencies. When you outsource with Enlyte, we’ll serve your medical claims with our premier services and bill review expertise, giving you the confidence, satisfaction and trust you need when selecting a bill review services provider. You can be confident your medical claims are being served by the industry’s premier service provider with decades of bill review expertise.
- Medical bill processing
- Mailroom operations
- Document management
- Data capture
- Provider contact center
- Specialized third-party liability demand services
Industry Trends & Insights
Get the latest insights and industry updates you need to know.
Find Out More
Combine industry-leading technology with deep market expertise to achieve exceptional claim outcomes. Schedule a consultation to learn more about our comprehensive suite of integrated casualty services and solutions.