Sentinel Claim Review

The Only Choice for Claim Auditing, Review and Negotiation

Sentinel Combines Available Technology AND Human Intervention to Maximize Client Cost Savings

Core Services:

• Complete Line-By-Line Claim Auditing
• Medical Documentation Audits
• Individual Claim Negotiation
• Treatment Source Contract Negotiation
• Experimental/ Investigational and Clinical Trial Research
• Chemotherapy/ Radiation Therapy Protocols and Audits
• New Technology and Pharmacology Research

Sentinel Claim Review: Unrivaled Cost Control. Real Results, Not Soft Dollar Savings. Experienced Professionals. The Only Choice for Claim Auditing, Review and Negotiation.

Sentinel Claim Review™ began its claim auditing services in 2001, when a prominent Underwriting company in New York sought expertise in reducing costs through the identification and correction of coding errors on medical claims. In its’ first year, Sentinel achieved over $1.1 million in savings on $9.4 million in claims. As a result, in July 2002, Sentinel Claim Review™ officially established itself as a medical claim review company. It has since continued to grow and produce staggering savings for its clients nationwide.

Sentinel provides reviews of medical and hospital claims for reinsurance carriers, third-party administrators, employers, and group health insurers through its staff of professional Registered Nurses. They also have numerous years of experience in the health insurance industry, having performed physician and hospital claim reviews, cost analysis and containment, and quality management for HMOs, PPOs, and TPAs.

Sentinel Claim Review’sTM staff of professional Registered Nurses have clinical expertise in multiple specialty areas including:

Sentinel Claim Review Goals:
Provide a professional, independent, and objective review of medical claims for the purpose of reducing costs associated with erroneous coding and billing practices.

Become widely-recognized as a source of research expertise on the most up-to-date information available on treatments, procedures, technology, pharmacology or services that are considered new, experimental, investigational, or in clinical trial.

Services Include:

• Line-by-Line Review of Provider Claims and Hospital Itemizations
• Medical Documentation Audits
• Experimental/Investigational and Clinical Trial Research
• Policy or Plan Document Interpretation
• New Technology and Pharmacology Research
• Provider Fee Negotiation
• Stop Loss Claim Adjudication

Sentinel performs reviews in accordance with the patient’s plan language, and any other applicable contract language (e.g. Stop loss contracts, PPO agreements) in effect at the time the services were rendered.

Confidentiality of information contained on a claim or in medical records submitted to our company is required of all employees. Records are retained for 180 days at which time they are destroyed by a secure medical document shredding company employed by Sentinel (unless there is a request for their return).