WC - Medical Bill Review Program

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Working to maximize savings and control workers’ compensation costs

Westfield strives to keep workers’ compensation affordable through our medical bill review program. Our advanced approach to medical bill review and bill negotiation results in substantial savings.

  • Bill review savings that can reach or exceed 57% of billed charges
  • National Preferred Provider Organization (PPO) network and savings
  • Fee schedule and jurisdictional adjustments
  • Out of network bill review
  • Usual, customary and reasonable review
  • Line item coding review and rebundling of charges
  • Professional nurse review
  • Duplicate bill detection
  • Expedited bill turnaround times

PPO Networks

Westfield’s PPO access includes over 750,000 physicians nationwide. The extensive physician network allows your injured employees to receive expert care close to where they live and work. Program features include:

  • Superior PPO utilization rates resulting from extensive and specialized network
  • National network including comprehensive selection of specialized physicians
  • Online physician lookup
  • Available medical directories
  • Physician panels tailored to your business

Physician Lookup

Access the Westfield Physician Lookup function with the button below. See the Physician Panel and Medical Directory page for more information about physician panels and medical directories.

Specialty Bill Review

Our specialty bill review services offer a detailed audit of complex medical billings and a specialized negotiation approach on appropriate cases. Compared to traditional repricing methods, specialty bill review achieves additional savings through the use of:

  • Certified coder reviews
  • Clinical audits by nurse auditors and physician advisors
  • Professional negotiators assigned to any bill over $2500
  • Comprehensive hospital bill audits and reviews
  • Review and negotiation of complex medical bills such as trauma, surgery, home health care, and surgical implants

Utilization Review (UR)

Westfield’s UR program strives to identify and provide medically appropriate care to expedite medical recoveries and return to work. Treatment plans are reviewed for medical necessity, frequency, duration and relatedness. This approach results in cost effective medical outcomes. Our UR services deliver appropriate, evidence-based treatment recommendations through:

  • URAC (Utilization Review Accreditation Committee) accreditation
  • National capabilities with licensures to meet jurisdictional guidelines
  • Precertification reviews
  • Concurrent reviews
  • Retrospective reviews
  • Peer reviews

Contact Information

Westfield Insurance
C/O Rising Medical Solutions
P.O. Box 3098
Milwaukee, WI 53201-3098

Please call 877-WST.FLD1 (877-978-3531) with any general billing questions or contact a Westfield claims professional at 800-243-0210 with any claims or coverage questions.

Learn more about other WesCare® programs by using the links on this page or by contacting Westfield.

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