Specialty Bill Review & Negotiation

Reduce disputes and strengthen payment integrity

Our specialty bill review and fee negotiation services combine clinical expertise, advanced analytics, and national pricing benchmarks to bring greater accuracy and transparency to complex medical billing.

We help payers and claims administrators control healthcare costs while ensuring fair reimbursement and provider alignment.

By leveraging data-driven insights and evidence-based clinical review, we evaluate high-dollar and specialty medical bills for accuracy, medical necessity, and compliance. Through proactive fee negotiation and benchmarking, our team delivers savings, reduces disputes, and supports stronger financial outcomes—without compromising the quality of care or provider relationships.

Solutions continued

Usual & Customary
(U&C) Charge Review

Compares billed charges against national and regional pricing benchmarks to ensure payments reflect fair market value and consistent reimbursement practices.

Appropriateness Review

Evaluates the clinical suitability and level of service for procedures, treatments, and length of stay to confirm they align with accepted medical standards and evidence-based guidelines.

Medical Necessity Review

Assesses whether the services provided are clinically justified based on diagnosis, condition severity, and established treatment protocols, helping ensure care is both essential and cost-effective.

Key Specialty
Services Include

Clinical Bill Review

Implant and Device Bill Review

DRG and APC

Out-of-Network Bill Review

Fee Schedule Compliance

Specialty Procedure Review

Facility Bill Review