ICD-9, HCPC and CPT Code Review
  • We review bills to ensure correct usage of industry standard coding of diagnoses codes and various standard procedure code sets.
  • Our process supports the American Medical Association's guidelines for billing and coding.
Reasonable and Customary Rates
  • We use a national database comprised of provider charges for each geographical area within the US to evaluate the charges for a particularly provider.
  • Evaluation of each DME claim including reimbursement recommendations for custom-fitted orthosis and prosthetics.
  • DME pricing for both rental purchase and rent-to-purchase agreements.
State Specific Fee Schedules in NY, PA, HI, UT, and NJ
  • In these states, specific fee schedules have been adopted by the various legislatures for the pricing of auto claims. We support all specialty tables.
Review of Bundled and Inclusive Services
  • We review each bill to ensure that providers are adhering to standard billing practices in regards to services that should be combined into a single code or billing an extra code for a service included in another.
Evaluation of Hard and Soft Duplicate Bills
  • Hard Duplicates are bills where the same claimant, same date of service, same service, and same provider are billed a second time.
  • Soft Duplicates are bills where some of the information contained may match bills already priced, but that are not 100% the same. Our staff investigates all soft duplicate bills to determine duplicate status and recommend payment where appropriate.
Pharmacological Evaluation
  • AWP pricing service available.


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For more information please contact Info@artisanclaims.com