ALPS Services

By outsourcing your services for cost control you are employing the best staff without the overhead. We monitor your health care program and all aspects of patient cost control.

Are Your Profits Being Threatened?

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

We offer a full range of review services, including:

    • Waste, Fraud and Abuse Review
      (Detecting, correcting and preventing so that quality healthcare is affordable to everyone)
    • Beneficiary Assessment and Screening
      (Pre-Admission Screening Resident Review Level II Evaluations (PASRR))
    • 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)
    • Pharmaceutical Review
      (Verifies utilization and cost of pharmaceuticals is appropriate, medically necessary, and related)
    • 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)
    • Physician Case Management
      (Enhanced medical outcome, improved dispute resolution, and facilitate better peer to peer communication)
    • 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)
    • Provider Credentialing
      (Verifying the medical provider professional qualifications including but not limited to relevant training, licensure, certification and academic background)

Customer-Focused Flexibility

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