ALPS Services, Inc. provides comprehensive medical cost containment services including utilization management, cost control, and quality assessment services throughout all health care settings.

We offer a full range of review services, including:

• Medical Records & Medical Bill Review
  (Review medical records in compliance with HIPAA standards and verify that the patient was charged only for services received)
  
  
• Coding and DRG Validation
  (Each claim is reviewed for possible savings potential)
  
  
• Managed Care Review
  (Ensure that only appropriate and necessary care is delivered in the least restrictive settings by qualified professionals)
  
  
• Pre-admission & Outpatient Pre-certification Programs
  (Investigate and verify pertinent medical issues regarding proposed treatment and/or hospitalization)
  
  
• Pre-surgical Review & Second Surgical Opinion
  (Certifies the medical necessity of proposed surgery)
  
  
• Concurrent Hospital Treatment Review
  (Certifies the medical necessity of continued inpatient care)
  
  
• Pharmaceutical Review
  (Verifies utilization and cost of pharmaceuticals is appropriate and medically necessary)
  
  
• Length of Stay Determination
  (Verifies that the length of stay is medically necessary)
  
  
• Discharge Planning
  (Ensures that the patients' needs are met after being discharged from a hospital)
  
  
• Case Management
  (An integral part of pre-certification, physician peer review and discharge planning. Ensures continuity of care. Contains costs by eliminating or reducing unnecessary utilization of resources. Improves patient satisfaction and quality of care)
  
  
• Retrospective Review
  (Post medical treatment analysis to determine whether services and costs were reasonable, usual, and customary)
  
  
• Claims Audit
  (Identifies benefit discrepancies and erroneous claim payments)
  
  
• Claims Processing
  (Accelerates the medical claim process)
  
  
• Quality Review/Quality Assurance Assessment
  (Monitoring, evaluating, and/or improving the quality of health care delivered by a health care provider)
  
  
• Medical Record Abstraction
  (Ensuring quality assurance methods to enhance reliability and validity of data obtained from medical records)
  
  
• Surveys and Data Collection
  (Verification of medical data and delivery of medical services)
  
  
• Subrogation (Third Party Liability)
  (Investigate, evaluate and recovery services on a contingency fee basis)
  
  
• Medical Records Transcription
  (Easy to use automated system helps to deliver fast, accurate and reliable service)

This full range of services is offered to all clients as a comprehensive package. However, any one, or any number of these services, can be unbundled to meet your needs. This customer-focused flexibility is, we believe, one of the key benefits of our service, and our key competitive advantage.