Bill Review

WCS provides a complete bill review service that includes both Anthem Blue Cross PPO and California Fee Schedule repricing for professionals and hospitals. One of the unique features of our program is the benefit of “lesser of” language in most of our institutional contracts. This provides our clients with the best pricing of each individual bill, PPO or California Fee Schedule, whichever is most favorable to our client.

The repricing process is as follows:

Submit bills to WCS electronically, by mail or courier
Bills are repriced and returned to our clients for payment
Payment recommendations and Explanation of Reviews are returned electronically, by mail or courier

We provide a customer service department that responds to all provider inquiries and to resolve disputes. WCS provides expert witness testimony for any litigation that takes place at the WCAB.

Non Network Review

In addition to pricing to PPO and fee schedules, WCS has the ability to address non-network ambulatory surgery center bills. This is a critical area since a fee schedule is not currently in place to regulate appropriate payments for these services. WCS creates a process specific to our client’s requests in this area. We have the ability to price to ‘usual and customary’ rates, negotiate rates based on other Anthem Blue Cross compatible rates, and utilize other tools that reduce payments to providers.

Out of State

Anthem Blue Cross provides full bill review services nationally.