PACO CONSULTING, INC.
P.O. Box 2080
Long Beach Township, NJ 08008
ph: 856.829.7449
fax: 888.380.8550
patti
PACO Consulting, Inc. is proud to offer our clients a variety of comprehensive services from early assessment to case closure.
PACO Consulting's case management programs are effective tools for managing the coordination of medical care and meeting full recovery and return-to-work objectives.
Our nurse case managers work closely with a full team, including but not limited to the patient, the employer, insurer and treating providers, to ensure that the best medical options are utilized.
Both telephonic and field case management services are available for the following types of claims:
• Workers' Compensation
• Auto / PIP
• STD / LTD
• Catastrophic /Multiple Trauma / Burns
PACO Consulting uses up-to-date technology and highly-trained medical analysts to review workers’ compensation and auto liability medical bills. All provider bills are reviewed and reduced to state fee schedule / usual, reasonable and customary fees or preferred provider adjustments.
If preferred provider discounts do not apply, then the bill will be referred for out of network negotiations for a desired rate within applicable timeframes.
Bill Review Services include:
• Coding review and re/unbundling
• Reasonable and customary review
• Fee schedule analysis
• Out-of-network bill review
• PPO management
• Repricing
Resulting Benefits:
• Multiple quality control checks
• Identification of over-utilization and
unnecessary care
• Timely turnaround of bills
• Historical database for provider treatment
patterns
• Data integrity
• Reduced medical costs
• Customized reporting
PPO Network Solutions Include:
• National Preferred Provider Networks
• Additional Ancillary Networks Available
• Pharmacy Benefit Networks
Large Bill Negotiations Services Include:
· Deep discounts on out-of-network claims
· Claims successfully negotiated up to 90%
of the time
· Provider sign-off is secured on 100% of
negotiated claims to avoid disputes
Out-of-Network Negotiation Services offer:
· Guaranteed Results or its Free
· Significant Discounts
· 100% Provider Sign-Off
PACO Consulting, Inc. is a Certified Act 6 Peer Review Organization (PRO) within the Commonwealth of Pennsylvania. Our PRO Act 6 Peer Review & Medical Record Review products meet strict quality and time restriction standards.
Our Act 6 Peer Review (PRO) & Medical Record Review Services Include:
The collection of all appropriate medical documentation for review
A thorough, objective analysis of medical records by a board certified specialist
License and specialty to determine the appropriateness of treatment
Determination of medical necessity, goal oriented treatment, causality issues and appropriate documentation of patient response to treatment program.
Rationale for opinions based on accepted standards of medical practice
A complete report with clear recommendations for denial or future management of Treatment
Report review by a Nurse to assure quality and clarity
Utilization Review services scrutinize the treatments, equipment, expenditures, and/or other issues related to an individual's care to determine if they are reasonable and appropriate for the diagnosis.
PACO Consulting's services include:
Independent MedicalEvaluations (IME):
An IME provides a clinical examination and review of the patient's available medical records by a clinician to determine a patient’s current medical status, relationship of claimant’s diagnosis to injury, need for continued treatment, and extent of disability.
Second Opinion:
A second opinion is the process of seeking an evaluation by another doctor or surgeon to confirm the diagnosis and treatment plan of a primary physician, or to offer an alternative diagnosis and/or treatment approach.
Radiology / Diagnostic Reviews:
PACO Consulting utilizes Board Certified Radiologists to review studies such as X-rays, CT Scans, and MRIs. The reviewing physician may confirm or refute original study findings. A final report with clear and concise recommendations by the reviewer for denial or appropriateness will be provided.
Copyright 2013 PACO Consulting, Inc.. All rights reserved.
PACO CONSULTING, INC.
P.O. Box 2080
Long Beach Township, NJ 08008
ph: 856.829.7449
fax: 888.380.8550
patti