WORKERS’ COMPENSATION BILL REVIEW
Take Control of Medical Spend with an Integrated Suite of Bill Review Solutions
When bill review tools, workflows and vendors operate separately, medical spend climbs, decisions slow down and compliance becomes harder to manage. Enlyte’s Bill Review suite helps address these challenges by unifying every component of your claims workflow in a single integrated solution, giving you greater control over medical spend without increasing administrative overhead or compliance risk.
Key Metrics
78%
Average Reduction on Billed Charges
12%
Greater Reduction in Medical Spend Over Competitors
99.9%
On-Time Fee Schedule Updates
80%
Automated Bill Processing
Advancing Your Claims Program
End-to-End Bill Review That Takes Your Program Further
When bill review, pharmacy, case management, utilization review and PPO work together in a single workflow, you capture greater savings through precision and control across every stage of the claim.
Capture More Savings with Lower Cost Strategies
Achieve greater total reductions by shifting savings to lower-priced containment strategies that maximize results while minimizing expenses.
Unlock Additional Savings with Post-Bill Review Solutions
Apply the right solution at the right time to capture greater savings while preserving provider relationships.
Connect Cost Containment Directly to Your Claims System
Integrate bill review, utilization review, networks and pharmacy directly into your claims system to eliminate manual touchpoints, speed bill processing and reduce leakage.
Measure, Monitor & Tune Performance
Leverage real-time analytics and configurability to refine performance and align cost containment strategies with your unique business strategies.
Maintain Confidence in Regulatory Compliance
Protect your organization from compliance risk, fines and penalties with regulatory expertise that ensures fee schedule updates are implemented quickly and accurately to safeguard your reputation.
SmartAdvisor
Elevate your medical cost containment strategy with SmartAdvisor®, a leading platform that delivers precise medical bill review and unmatched configurability aligned to your risk tolerance. Beyond standard fee schedules, proprietary clinical edits uncover additional savings while no-touch automation ensures only bills that truly require review reach the right expert at the right time. Integrated directly into your claims system and existing workflows, SmartAdvisor creates a more connected and efficient bill review process. The result is greater savings at a lower cost structure, giving you tighter control over medical spend without sacrificing quality.
Cost Containment Levers
Bill Audit
Enhance savings with AuditPro, a bill auditing solution combining advanced technology and clinical expertise to identify billing errors other systems miss. By validating codes and charges against medical records, AuditPro uncovers additional savings across professional and facility bills without disrupting workflows or extending payment timeframes.
Specialty Bill Review
Protect time and resources with FairPay Flex, which delivers substantiated usual and customary pricing for medical bills. Supported by experienced bill reviewers, nurses and compliance experts, this specialty bill review solution helps ensure regulatory alignment while diminishing the threat of overpayment.
Negotiation Services
Secure fair and reasonable pricing through direct-to-provider negotiations that deliver meaningful discounts on medical bills. Using prompt-pay, data-enhanced and strategic negotiation approaches, these services address out-of-network bills across a wide range of bill types.
ePay
Move beyond inefficient paper-based payment processes with secure electronic transactions. ePay accelerates payment cycles, reduces administrative costs and gives providers the flexibility to choose their preferred payment method.
eBill
Improve claims efficiency and reduce operating costs with electronic medical billing that connects providers and payers in a single digital workflow. eBill helps ensure compliance with state reporting requirements while shortening billing and payment turnaround times.
What You Gain
Fair and accurate bill repricing through precise bill review and advanced clinical edits
Reduced regulatory risk through accurate fee schedules, compliant pricing and consistent reporting across jurisdictions
More time for high-value claims work by automating routine bill processing
Simplified program management by eliminating the friction, delays and data inconsistencies common with multi-vendor solutions
Insight-driven decisions with comprehensive market intelligence that help you adapt to operational performance, regulatory shifts and changing risk tolerance
“Enlyte has expanded its back-end bill review process to identify additional savings categories and maximize cost containment. They have also reviewed our PPO networks to optimize discounts. These reviews provided us with additional savings and reduced the overall cost of our program.”
—Claims Manager, State Fund
Bill Review Trends & Insights
Get the latest insights and industry updates related to medical bill review.
Capture Every Possible Dollar of Savings
Connect with us to learn how integrated bill review can help you gain greater control over medical spend while minimizing complexity across your claims workflow.
Frequently Asked Questions About Workers' Comp Bill Review
How does clinical editing improve bill review savings?
Clinical editing improves bill review savings by identifying billing anomalies and inappropriate charges. Enlyte’s clinical edits deliver about 3.5% additional savings beyond standard fee schedule reductions.
What level of automation can I expect with Enlyte’s bill review solution?
Enlyte’s automation processes most medical bills without manual intervention, routing only complex cases to specialized reviewers. This speeds processing, reduces administrative workload, and frees up claims handlers to focus on higher-value claim management tasks.
Is it difficult to integrate bill review with my existing claims system?
Integrating our bill review solution with your existing claims system is a structured and flexible process supported by our proven model office approach. Using preconfigured best practices, we streamline configuration, minimize IT effort, and enable efficient implementation. Built on successful deployments across many organizations, this framework helps accelerate implementation on our side while allowing you to tailor the solution to your unique workflows and business needs.
Can bill review integrate with platforms such as Guidewire?
Yes, Enlyte’s Bill Review solution includes a pre-built integration that connects Guidewire ClaimCenter with SmartAdvisor through a cloud-native Guidewire Accelerator, enabling near real-time data exchange, straight-through processing and configurable auto-approval rules.
How do integrated bill review solutions impact compliance risk?
Compliance in workers’ compensation depends on timely fee schedule updates and accurate state reporting. Enlyte supports this with dedicated regulatory expertise and 99.9% on-time fee schedule updates, reducing compliance risk across jurisdictions.
What if I only need one component of the bill review suite?
Enlyte’s Bill Review solutions are flexible and scalable to fit your needs. While the integrated suite delivers greater savings, you can also implement individual components such as bill review, bill audit, specialty bill review, negotiations, ePay or eBill based on your program needs.