BHN’s Workers’ Compensation PPO network provides an extensive panel of workers' compensation knowledgeable physicians in addition to providing automated bill review and below fee schedule discounts. BHN’s system is integrated to automatically flag bills for nurse review. BHN staff accesses this system directly for set-up and processing of claims. Bills flagged for nurse review include hospitalizations and outpatient bills greater than $5,000, psychiatric care, nervous system testing, chiropractic bills over $2,000, surgical bills for multi-line procedures, and surgical bills greater than $1,000
BHN payments are processed timely and efficiently. BHN assures the client quality and accurate payment by requiring appropriate information is received regarding diagnosis, treatment, and prognosis before payment . Upon receipt of this information, the bills are processed for payment within five days and EORs are sent to the client for payment.
After these bills are reviewed, the files are reviewed for additional involvement by nurses and adjusters. BHN has medical professionals on staff to assist the medical management of cases. Utilization review, peer review, and specialists’ reviews are utilized to control medical costs and prevent unrelated services. Discounts of 15% and greater below fee schedule by utilizing the PPO and bill review services have been achieved. The system reviews each bill for appropriate services, fees, and adjudicates claims to fee schedule or less, dependent upon bill review, PPO, and negotiated savings.