PROVIMATM is the proprietary, secure program set PMG uses to communicate with our employers, clients and physicians over the internet. We also use PROVIMATM to oversee and track every aspect of medical care and the bill review process that pays for that care.
PROVIMATM is a web-based software system written in Cold Fusion, the most powerful rapid application development tool currently in existence. We use Cold Fusion to create "dynamic web pages" that communicate with databases and other applications to display information and interact with bill review, case management and claim management applications.


Bill Review
The PROVIMATM bill review system allows competent reviewers to adjudicate a medical bill for payment from anywhere at any time over an intranet or through the internet. Program edits allow for enforcement of contracts, state laws, plan design and coding guidelines. Other routines search for duplicate line items within a bill or alert reviewers when predetermined conditions ("red flags") are met. Pricing algorithms allow reimbursements to be referenced to fee schedule lists, relative value units (RVU's), Medicare Allowable, Usual & Customary Fees or variations on the above. Carve-out fees are supported at both the physician and procedure level. PROVIMATM can transmit or accept billing information in electronic, paper or scanned formats.
Bills processed in PROVIMATM and approved for payment can be uploaded directly into a payer's check writing system.

All information is protected by multi-level security features that include: Server-side secure socket layers (SSL), internal software/hardware firewalls, and permission-based access levels on the client side

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Case Management

The PROVIMATM Case Management module can function as a stand-alone program or can be used in conjunction with other program sets. It features Call Center support, diary entry, authorization, plan design lookup and other useful tools desired by nurse case managers and administrators. The Case Management module can also be set to reference popular treatment guidelines in a "see-through" mode that are available in electronic format. In the stand-alone configuration, the program set also includes separate demographic screens and links for patients, dependents, payers, doctors and attorneys.

Assisting patients, doctors and plan administrators takes a lot of record-keeping and a lot
of cross-referencing. Our case management system simplifies that process and standardizes the recorded information so that data can be retrieved, sorted and acted upon to keep the oversight process running smoothly.
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Patient & Provider Demographics
PROVIMATM utilizes comprehensive patient and provider demographic screens. That means, we can track patient-related data such as multiple injuries, multiple plans, dependents, employers and adjusters, in addition to standard required information.

For physicians, we track multiple locations, multiple FEIN's, specialties, subspecialties, office hours, contacts and when necessary, an entire set of credentialing data to support network credentialing verification.
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Outcomes & Reporting
Tracking clinical and economic outcomes for outpatient treatment is one of the most difficult challenges for physicians and health plans alike. Acquiring consistent, relevant data is difficult because it can take so many different forms and because so many of those forms are paper outputs generated by disparate billing and payment systems.

Under the PROVIMATM system, virtually every patient encounter can be recorded, cataloged and tracked so that payers and providers can be afforded instant summaries of patient treatment along with reference to applicable treatment standards. What that means to our clients is better information, faster, for making informed decisions about medical care, return-to-work and setting reserves.
Our goal is to reduce the uncertainty, and
thus the risk, associated with
specific work-related
injuries and disease
conditions.
Reports are available on-line to authorized individuals. The reports are grouped by topic and entity to simplify the selection process. Reports are also designed to be multi-functional: Within a given report, you select the category of information, the time-frame, and any of the other applicable parameters. A custom report is then generated based on your exact query.

Reports are available in the following categories:
  • Savings
  • Medical Payments
  • Clinical Outcomes
  • Return-To-Work Outcomes
  • Economic Outcomes

    Reports may be queried by:
  • Plan
  • Employer
  • Patient/Claimant/Subscriber
  • Provider
  • Adjuster
  • Diagnosis
  • Treatment modality
  • Time frame.
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    • Provider Search & Location
    Payers and employers spend a lot of precious time searching for the right doctor in the right location. With the Provider Search & Location function in PROVIMATM, authorized personnel can quickly locate and select physicians, clinics, hospitals, therapists, MRI/radiology services and other ancillary providers.

    When looking for a provider, you may search by:
  • City
  • County
  • Zip Code

    Then select by:
  • Primary Care
  • Hospitals
  • Specialists
  • Ancillary Providers
    		•
    Where available, information on foreign languages spoken and office hours is provided for each practice, along with the address, phone number and any special remarks.
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    Bill Review
    Case Management
    Patient & Provider
    Demographics
    Outcomes & Reporting
    Provider Search &
    Location











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