Medical Legal Support for Medical Professionals

Some specific service benefits EPS can provide to Medical Professionals
in preparing files for arbitration:

  • Confirm to see that eligibility was established and that the patient is eligible for PIP benefits under the policy
  • Ensure that treatment is pre-certified and that all appeals were executed to the appropriate carriers; if not, EPS can perform those tasks
  • Ensure that all claims have been submitted to the appropriate carriers within the given timeline according to the insurance’s decision point review plan
  • Establish that the treatment has been determined to be medically necessary

Medical Legal Support for the Attorney

For attorneys, we can save you time and money by ensuring that the files are fully audited for all arbitration criteria and are ready to submit, eliminating potentially costly refilling issues. We provide honest assessments prior to arbitration to avoid unnecessary or poorly conceived legal processes.
Our step-by-step services begin with analyzing the medical file, preparing the file for arbitration, processing the file with Forthright and keeping track of the process calendar. EPS verifies the insurance policies to make sure that the claimant has the ability to pay prior to filing the claim for arbitration, and we can also help in preparing the responses prior to the file going to hearing.

Services that are provided prior to sending the files to arbitration:

  • Check to make sure that there is enough money left on the policy and that the patient is eligible for PIP benefits under the policy
  • Ensure that all necessary pre-certifications and appeals were sent to the appropriate party
  • Provide two samples of appropriate UCR payments
  • Establish that the treatment was medically necessary
  • Prepare the arbitration file to be sent to Forthright
  • Tracking and maintaining all correspondence relative to the file

EPS works on the behalf of attorney’s and medical professionals to analyze files and prepare them for successful arbitrations. EPS provides a full scale audit and analysis of your PIP files to ensure successful outcomes in arbitration for both the attorney and medical professional alike. Elite Physician Services utilizes its over 22 years experience in the PIP arena to successfully complete these onerous tasks which overburdened staff generally don’t have the time or specialized knowledge to handle as efficiently as our experts.
In fact, EPS successfully settles 65% of files before they go to arbitration… and when they go to arbitration, EPS is successful 85% of the time.

EPS will coordinate with your office personnel to go beyond what your staff can do. EPS will tackle those onerous clerical tasks that keep them from the important job of patient care. Our expertise and wide-ranging resources will help you build your business and increase profitability while making your staff more satisfied with their performance. How? EPS does not believe in cutting staff – we believe in enhancing your staff to be the best they can be.

EPS collaborates with your staff and lets them focus on what they do best - patient care and medical services. We handle those time-consuming, burdensome but necessary functions such as patient qualification, billing, collections, post-payment appeals, coding audits and so much more. Job satisfaction will increase as you deliver patients the best care possible. For over 22 years we’ve enhanced our clients’ operations and profits and helped them build better teams. Explore our site and see why partnering with us is a healthy move, and why your staff will agree.

Start With A Free Audit!
Let us start with a complete analysis of your current A/R. We will show you where you can save money, increase profits and improve efficiency – and we’ll do it at no charge!

EPS is a complete provider of medical business solutions for physicians, hospitals and ambulatory surgical centers. At EPS we will take the time to walk you through our exciting array of services to see what best suits your needs. Best of all, you can pick and choose the services you want, from simple back-office enhancements to full team-building or complete support functions. We will tailor our services to your needs. We can help you with billing, collections, scheduling, pre-certification, claims, follow-ups, procedure assessments, receivable funding, insurance eligibility, auto claims, expense and overhead analysis, medical legal services and policy/procedure protocols.

BULLETIN NO. 10-30

TO: ALL NEW JERSEY PRIVATE PASSENGER AUTOMOBILE INSURERS AND MOTORBUS INSURERS AND THE NATIONAL ARBITRATION FORUM

FROM: THOMAS B. CONSIDINE, COMMISSIONER

RE: INTERPRETATION OF DOBI RULES ON PIP REIMBURSEMENTS

It has come to the Department’s attention that some Dispute Resolution Professionals (DRPs) have issued decisions that disregard our administrative rules. The purpose of this Bulletin is to identify some examples of this practice and to remind insurers, the Department’s PIP arbitration vendor and DRPs that, in accordance with N.J.A.C. 11:3-5.4(a)8, the determinations of the DRPs shall be fair, efficient and consistent with substantive law and the Department’s rules for the handling of PIP claims.

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