Medical Services
Our physicians represent every specialization of the medical community. Routinely, they review medical records for the purpose of determining whether the services for which the claims are submitted are reasonable, appropriate, and medically necessary.
The medical opinions expressed by our consultants depend on the documentation provided by the treating physician. Each treating physician is required to document the elements of treatment given for the diagnosis.
We encourage submission of complete medical and billing records on each claim we review to include any accident information that may be available.
Physician Peer Reviews consist of medical necessity, causation, undocumented charges, and usual and customary charges within the reviewing physician's scope of practice.
Peer Review Services
Physician Medical Review
All medical reviews are comprised of a summary of the case, along with the expert’s opinions and recommendations. The report also encompasses a breakdown of the billing by provider, medical necessity, causation, undocumented charges, and usual & customary fees. Any questions, concerns and comments written on the request form under Special Instructions will be addressed. Please note, prices may vary depending on the size of the case file in which the expert needs to review and the level of complication.
Medical Opinion Only (no bills)
The expert reviews the medical records concerning the care and treatment of the claimant, providing an opinion and addressing any specific questions requested. Actual billing is not reviewed or addressed. These experts may include Life Care Planners, Vocational experts, Economic experts, Actuary experts, and others. Price starts at $2,500+.
Chiropractic Reviews
Price varies between $1,000 and $1,400+. Based on volume and complexity of the file.
MD Reviews
Price starts at $1,500+. Based on volume and complexity of the file.
Film Reviews
Complete radiological review of films with a detailed report: Price starts at $500 per MRI /CT study. Plain film X-Rays are $200 per study. A cost affidavit may be produced for an additional fee.
Film Reviews
Complete radiological review of films with a detailed report: Price starts at $650 per MRI /CT study. Plain film X-Rays are $350 per study. A cost affidavit may be produced for an additional fee.
Verbal Report/Telephone Conference
Need a verbal report from our expert before a report is produced? We can have our expert call you to discuss his/her findings. Our legal department can also set-up a teleconference with our expert for you on a case that has already been completed. Please allow 48 hours for scheduling. Price starts at a minimum of $350.
Line by Line CPT Coding Bill Audits
Billing Specialist/RN Line by Line Bill Audit (Usual & Customary)
A billing specialist or RN reviews the records and bills to determine if they are in line with current National Fee Guidelines. Pricing is based off how many lines/codes and the number of providers: 1-10 lines= $300 per provider; 11-50 lines = $450 per provider; 51-100 lines = $600 per provider; Each additional 50 lines is an additional $150 per provider. *Per case audit report fee is $225. *Cost affidavits may also be produced for $275 for each provider by the Billing Specialists or RN.
Future Treatment Audit Report
A billing specialist or RN reviews the records and bills regarding estimates provided on future care to determine if fees are in line with current National Fee Guidelines. Surgical estimates and Life Care Plans may also be included for review. Pricing starts at $300+ per provider.
Radiological Bill Audit
Conducted by a Radiologist who provides an in-depth analysis of the MRI/CT pricing for the geographical area in which the service was provided. Price is $550 per MRI /CT study.
In House - Line by Line Bill Audit (Usual & Customary)
Charges are reviewed "In-House" by NAC to determine if they are in line with current National Fee Guidelines. (Usual and Customary variances are completed by inside personnel using CPT fee guidelines.) Bills and records are NOT reviewed for medical necessity or length of treatment. Each provider = $150; billing over $25,000 on any 1 provider may incur an additional fee. *COST AFFIDAVITS ARE NOT AVAILABLE WITH THIS SERVICE. A BILLING SPECIALIST OR RN MUST BE UTILIZED.
Nurse Reviews
Comprehensive Nurse Review
A Nurse summarizes the file identifying any billing errors, obsolete codes, unusual codes and/or unrelated codes. This report gives the claims professional a basis by which to negotiate and settle their claim without the need for litigation. This report makes recommendations per the Official Disability Guidelines. Base fee: $750. An additional fee will apply for a line-by-line audit. Add an additional $250 for each affidavit, if requested.
IME Services
Independent Medical Evaluation (IME)
An independent physician will examine the claimant. The physician will be based on the specialty you indicate under special instructions on the front of this form. Price: $1,200+ expert fee.
Combo
Physician Peer Review and IME performed by the same physician with two separate reports. Price: $2,500 + expert fee.
Motion To Compel IME Report
Expert reviews the medical records for care and treatment of the claimant then gives an opinion on if an IME is warranted. Included will be an explanation of what will happen during the IME exam and why it is necessary. Prices start at $1,000+. A medical necessity affidavit may be produced for an additional fee.
Miscellaneous Services
Record Retrieval
Base fee: $45 per hour plus any fees charged by providers.
Investigations
NAC offers a wide range of Investigation Services. Please see our NAC Investigative Request Form for more details.
Designation Only
If you have an expert designation deadline, we have authority from numerous experts to designate them ahead of time. You must notify NAC prior to designating one of our experts. If we receive the case, the designation fee is credited toward the cost of the review. Price is $150 per expert being designated.
Designation with Special Report
Designation of an expert and quick turn-around time of a partial/supplement report purely for designation purposes. The Expert’s report would be based on limited information available and time allotted for the report. Cases can usually be turned around in 24 hours or less. A rush fee will apply for the Expert only. Price varies on a case-by-case basis.
Please note: Our physicians are under contract and are required to testify on behalf of their handling of any report if requested. We require that all communication regarding deposition or testimony in conjunction with cases be coordinated through North American Consultants for control purposes. Please contact: Legal@NorthAmericanConsultants.com
Submit a Medical Service Request