---
title: Prizm - Third-Party Medical Review
---

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## **Third-Party Review: Auto and Liability**

We are the best resource to help formulate your demand package. An accurate and reasonable measure of what is owed on past and future medicals is needed for a demand package. PRIZM provides clients with detailed data analytics and profile in a comprehensive report. Upon request for review PRIZM will:

- Ensure bills are coded properly
- Determine accurate UCR, Fee Schedule or Medicare values
- Identify inappropriate billing e.g., upcoding, unbundling and balance billing
- Provide values to assist settlements

## **The PRIZM Difference**

Certified Professional Coders (CPC) or Nurse Certified Professional Coders conduct the audit. We provide detailed, fact-based narrative for each deduction analyzed. Coders can present as expert witnesses to defend all report findings. 

## **Bill Review Triggers**

- Improper coding or format
- Unmanaged or unverified medical bills
- High ambulatory surgery center bills
- No medical bills in the file only procedures and reports

### **Tier 1: Preliminary Review**

- Key medical bills.
- Produce Explanation of Benefits (EOBs).
- Detail provider charges and reductions.
- Identify and remove duplicates.
- Zero out all charges prior to date of loss.
- Provide top and bottom line demand values.

### **Tier 2: CPC Review**

- Complete Tier 1.
- Review of medical records and bills by CPC.
- Complete summary report by CPC.
- Provide testimony as needed.

### **Tier 3: Nurse CPC Review**

- Complete Tier1.
- Review of medical records and bills by a Nurse CPC.
- Complete summary report and medical necessity comments.
- Provide testimony as needed.

### **Physician Review or Exam**

- Identify pre-existing conditions.
- Determine medical necessity and complexity.
- Use findings to revise bill review totals.

PRIZM LLC 

523 Fellowship Road

Suites 275/280

Mt. Laurel, NJ 08054

P 856-596-5600

F 856-596-6300

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