WORKERS’ COMP SOLUTIONS
Workers’ Compensation Bill Review & Claims Management Solutions
Mitchell’s full spectrum of workers’ compensation solutions and services combines industry-leading software with technology-enabled services to help provide better outcomes.
Mitchell Can Help You: Manage Compliance | Review Medical Bills | Enhance Medical Management | Manage Pharmacy Claims | Navigate Medical Claims | Process Bills Electronically | Assess Performance
Maintain Medical, Fee Schedule & Regulatory Reporting Compliance
Mitchell helps our clients manage compliance with workers’ compensation regulations, including fee schedule and medical requirements and CMS and FROI/SROI reporting.
Medical & Fee Schedule Compliance
Mitchell employs a dedicated compliance team that not only follows the workers’ compensation legislative landscape but also helps to drive and inform its policies. Our compliance experts deliver regular industry updates to our Compliance Connection website. Mitchell delivers fee schedule data and other regulatory data updates to our software as needed.
Mitchell Regulatory Reporting Solution
Mitchell’s regulatory reporting solutions simplify the reporting process for our clients by providing a singular connection for state reporting and by including more than 10,000 mandatory and conditional edits. Our compliance team works directly with states on reporting requirement changes and monitors for updates.
We Provide Multiple Options to Help Our Clients With State Reporting
Assemble, manage and submit the required information in compliance with jurisdictional regulations in our easy-to-use, secure web portal.
Eliminate manual data entry by exporting FROI/SROI data from the claims management system. Submit ﬁles for IAIABC releases in a single ﬁle format.
Reduce the manual work involved with EDI compliance processes by automatically exporting raw claims and letting AutoTriggers take care of the rest.
Review Medical Bills & Contain Costs
Mitchell provides flexible and customizable solutions to help our clients contain and manage workers' compensation costs.
SmartAdvisor Medical Bill Review Platform
Mitchell’s industry leading medical bill review platform can be customized to our customers’ speciﬁc workﬂows to help them accomplish their unique business goals. The technology, supported by a highly sophisticated and Mitchell-owned rules engine, helps to drive consistency and accuracy in price for care. Additionally, our medical bill review clients have access to Mitchell Mosaic—a proprietary approach to sourcing and stacking PPO networks—and the dedicated teams and tools necessary to design and customize their workﬂows and outcomes.
Mitchell offers its medical bill review platform to its clients via one of three methods: licensed software, Technology Enabled Services or a hybrid model.
Technology Enabled Services
Free up time for adjusters to focus on high-value tasks and complex decision making by partnering with Mitchell’s Technology Enabled Services. The Technology Enabled Services team provides end-to-end business processing & specialty services with speed and accuracy, driving value to clients. Services include:
- Data Capture Services
- Document Management
- Full Bill Processing
- Certiﬁed Code Review
- Mailroom Services
- Quality Assurance
Our Technology Enabled Services Team Also Offers Additional Services That Add an Additional Layer of Cost Containment to the Bill Review Process
These additional services include:
Mitchell’s AuditPro bill auditing solution employs a unique blend of technology, data and expertise to detect billing errors, and 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.
Mitchell Specialty Bill Review
Mitchell’s specialty bill review solution provides usual and customary pricing to help payors consistently pay a fair and reasonable price for out-of-network medical bills when fee schedule pricing does not exist.
Mitchell Negotiations Services
Mitchell’s direct-to-provider negotiation services helps secure discounted rates on medical bills using a variety of strategies including prompt-pay, data-enhanced and strategic negotiations.
Automate & Enhance Medical Management Programs
Help reduce the cost and time historically required for medical review on referrals and bills.
Enhance your organization’s medical management program and teams with Mitchell ReviewStat, an intuitive web-based and highly automated workﬂow optimization solution built to facilitate and monitor the progress of cases for utilization review, peer review and case management.
Learn how the ReviewStat medical management software can help you realize greater efficiencies and increase productivity within your utilization review and case management teams.
Manage Pharmacy Claims
Mitchell ScriptAdvisor is the industry’s most complete PBM, integrating bill review, clinical and claims systems for a seamless experience and increased visibility across the claim.
ScriptAdvisor®, PBM Solution
- Dedicated Customer Service & Pharmacy Expertise
- Extensive National Network
- Comprehensive Clinical Programs
- Smart Technology and Pre-Build Integrations
- Robust Reporting & Analytics
- Regulatory & Compliance Expertise
Learn more about Mitchell’s full suite of end-to-end casualty solutions.
Receive Bills & Submit Payments Electronically
Mitchell's SmartBill solution processes electronic bills to help increase efficiency and drive savings for our clients. Mitchell understands the value of increasing eBill penetration and works directly with providers to encourage migration from paper to electronic billing.
Mitchell’s SmartPay solution offers end-to-end automated payment reconciliation, drives efficiencies in the payment process and helps reduce material and labor costs.
Industry Trends & Insights
Get the latest insights and industry updates you need to know.
A Deeper Look at Utilizing Generic Drugs in Workers’ Comp
June 5, 20235 MIN READ
According to JAMA, the Journal of the American Medical Association, during a ten-year period branded pharmaceutical products in the U.S. increased 159% by list price and 60% by net price. In a continued effort to combat rising drug costs workers’ comp pharmacy benefit managers (PBMs) look to substitute equivalent generic drugs for these more costly brand versions whenever possible.
Ask The Pharmacist: Drug Allergies Versus Side Effects in Workers’ Comp
June 2, 20233 MIN READ
True medication allergies are rarer than side effects, but are potentially more dangerous, and are a result of the activation and response of the body’s immune system to an “insult” or “foreign body.” Allergies occur across a range of severities, from mild to life-threatening, and often only occur on the second exposure to the drug, food or substance that triggers it.
High-Cost Topical Pain Meds Continue to Plague Comp
June 1, 20231 MIN READ
Pegged as a problem by the workers compensation industry nearly a decade ago, dermatological creams are increasingly being prescribed at a disproportionate cost to manage soft-tissue injuries, according to a recent study.
Assess Performance With Advanced Reporting & Analytics
Reveal Custom & Actionable Program Insights With Robust Tools
Mitchell provides a variety of both standard and ad-hoc reports for our clients, including but not limited to:
- SmartTracker Performance Dashboard
- Provider Analysis Report
- Industry Comparison Report
- Provider Network Performance Report
Mitchell Claims Performance Consulting
Mitchell offers consulting services to help clients gain a deep understanding of how their current Mitchell product features can be leveraged to meet the demands of a dynamic market.
Leveraging our rich database and reporting capabilities, our Claims Performance Consulting professionals use in-depth expertise to help clients identify untapped opportunities in their claims management processing as well as reveal custom, actionable insights and benchmark their results compared to the industry.