Validate Expected Reimbursement
Know what the bill should pay under the applicable jurisdiction-specific reimbursement methodology.
For RCM & Medical Billing Teams
Bring workers’ compensation reimbursement intelligence into your revenue cycle. Validate expected reimbursement before submission, identify underpayments after adjudication, and give your team the regulatory support to recover missed revenue.
Your RCM platform can manage billing, claims, denials, collections, and workflow.
Workers’ compensation adds another layer.
Every jurisdiction has its own fee schedules, reimbursement methodologies, coding requirements, and regulatory rules. Determining what a bill should pay requires specialized reimbursement logic that traditional RCM systems may not maintain.
Your RCM system manages the revenue cycle. BillSentry helps determine what the workers’ comp bill should actually pay.
BillSentry brings reimbursement validation upstream, giving your team visibility into expected reimbursement before a workers’ compensation bill is submitted.
Know what the bill should pay under the applicable jurisdiction-specific reimbursement methodology.
Surface potential reimbursement opportunities and billing issues before they become lost revenue.
Identify coding, modifier, and reimbursement-rule issues that can affect payment.
Validate professional and facility bills using applicable fee schedules, UCR methodologies, and state-specific reimbursement rules.
Better reimbursement starts before submission.
The revenue cycle doesn’t end when the EOR arrives.
BillSentry independently calculates expected reimbursement so your team can compare what should have been paid with what was actually allowed.
Find bills where payer reimbursement differs from the expected allowance.
Surface reductions and reimbursement differences worth investigating.
Focus staff on bills with meaningful financial impact instead of manually researching every payment.
Give billing and recovery teams the pricing logic and regulatory documentation behind the expected reimbursement.
Don’t work every discrepancy. Work the ones with money behind them.
BillSentry provides the workers’ compensation reimbursement intelligence. Choose how your team uses it.
Web Application · Bill Analyzer
Use it directly in your browser. No integration required.
Give billing, audit, and recovery teams a ready-to-use application for validating bills and finding missed revenue.
Bill Analyzer includes:
API
Already have your own workflow and analytics?
Embed BillSentry’s workers’ compensation reimbursement engine directly into your existing RCM or billing platform.
The BillSentry API provides:
Start with Bill Analyzer. Move to API when you’re ready. Or use both.
Provider Insights in Bill Analyzer
Finding one underpayment is useful. Finding the pattern behind hundreds of them is more valuable.
Provider Insights turns BillSentry’s bill-level reimbursement analysis into a broader view of revenue performance, helping RCM teams see where reimbursement opportunities exist across their workers’ compensation business.
Quantify potential reimbursement opportunities across bills and providers.
Surface higher-impact reimbursement opportunities so teams know where to focus first.
Identify codes and services associated with recurring reimbursement differences.
Find systematic billing and reimbursement issues before they repeat.
See where revenue is being missed. Then focus your team where it matters most.
Finding a reimbursement discrepancy is only the first step.
Recovering it may require showing why the reimbursement should have been different.
RuleTrace™ provides a transparent breakdown of how BillSentry calculated expected reimbursement.
RuleTrace™ shows:
Instead of simply telling your team:
Expected reimbursement: $1,240
BillSentry can show:
Expected reimbursement: $1,240. Here’s how it was calculated, the rule that applies, and the regulatory source supporting it.
The same reimbursement intelligence can support your revenue cycle at multiple points.
Before Submission
Validate reimbursement before the bill enters the payer’s workflow.
Validate → Correct → Submit
After Adjudication
Compare expected reimbursement against the payer’s allowance and identify potential underpayments.
Compare → Prioritize → Recover
One reimbursement engine. Two opportunities to protect provider revenue.
BillSentry can support different RCM workflows without requiring an all-or-nothing implementation.
Validate reimbursement before submission.
Compare expected reimbursement with payer allowances.
Analyze previously adjudicated bills for potential missed revenue.
Use Bill Analyzer and Provider Insights to identify patterns and prioritize opportunities.
Use the BillSentry API to bring reimbursement intelligence directly into your existing platform.
Start with one provider, one workflow, or one use case. Expand as needed.
Add specialized workers’ compensation reimbursement intelligence across provider clients without maintaining 50-state pricing logic internally.
Validate expected reimbursement before submission and identify potential underpayments after payer adjudication.
Improve workers’ compensation billing accuracy and identify missed revenue across locations, providers, and procedures.
Identify reimbursement discrepancies and support recovery efforts with defensible pricing documentation.
Providers and payers approach medical reimbursement from different directions.
Providers use Revenue Cycle Management to pursue correct reimbursement.
Payers use Payment Integrity to validate correct reimbursement.
Both ultimately need to answer the same question:
BillSentry provides the reimbursement intelligence needed to calculate that amount accurately and explain how the decision was reached.
Maintaining workers’ compensation reimbursement logic internally means tracking changing fee schedules, methodologies, coding rules, and regulations across jurisdictions.
BillSentry maintains that underlying pricing and reimbursement logic across all 50 states plus OWCP.
Your team can focus on revenue. We focus on the rules behind it.
Whether your team needs a ready-to-use application or reimbursement intelligence embedded inside an existing RCM platform, BillSentry gives you the pricing, rules, and documentation behind the bill.