Peregrin's provides the following for first party claims:
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Usual, Customary and Reasonable bill review in 72 hours
or less
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Prompt Pay Discount Negotiations for non-contracting
hospitals
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Utilization review to address issues such as medical
necessity, inappropriate treatment, pre-existing conditions,
and causal relationship to accident
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Panel of doctors available for record reviews and/or
IME's
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Deposition, arbitration, and trial testimony |
Basis for Review
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Usual, Customary, and Reasonable
fees per zip code are |
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Current AMA CPT-4 codes, with
descriptive terms and identifying codes |
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Adherence to usual and customary
treatment and billing practices
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ICD-9 diagnosis code checks
for unrelated charges |
PREFERRED PROVIDER NETWORKS
Peregrin contracts with PPO networks for reduced
rates for our participating payer clients. Contracts include
hospitals,
surgery centers, radiology centers, chiropractors, medical
doctors, physical therapists, and other providers.
This service
is a great benefit for your insureds. It allows them additional
treatment, if necessary, before exhausting
their Med-Pay coverage.
PEREGRIN PROMPT PAY PROGRAM
Peregrin offers a "Prompt Pay Program" wherein
a discount is negotiated in exchange for prompt payment for
hospital and surgery center bills for non PPO facilities,
or for carriers who elect not to use PPOs.
USUAL, CUSTOMARY & REASONABLE FEE SCHEDULE
Peregrin utilizes
one of the most recognized UCR databases in the United States:
Ingenix/Medicode of Salt Lake City.
The Ingenix database contains values for all 7,000 CPT codes
by 3 digit zip code, nationwide.
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Based on statistical
analysis of actual provider fees
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Updated every
six months
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Ingenix stands
behind and supports each data base value |
Upon request, Peregrin will consult our utilization review
doctors for their expert opinions when we receive bills that
have unusual or questionable treatments or diagnostic procedures.
The medical experts provide justification for not recommending
reimbursement on questionable practices that are not accepted
by the medical community or may not be in the provider's
scope of practice.
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