PRAIRIE STATES NURSES' EXPERT ANALYSIS CONTROLS COST THROUGH BILL AUDIT PROGRAM

Prairie States’ bill audit program is a signature service designed to catch duplicate, fraudulent, or inappropriate charges on inpatient hospital bills and then fight to ensure that those charges are not paid. Every inpatient and surgical claim is scrutinized, as well as any other claim over $5,000. This program is an extremely effective tool for saving on plan costs – and it’s a service unique to Prairie States.

All bill audits are performed by Prairie States’ in-house team of highly trained registered nurses, all of whom have extensive clinical experience. These medical professionals understand the big picture, and make sure that only what belongs on a patient’s bill will be paid—and at the right cost.

Once a claim has been identified for bill audit review, a dedicated nurse will walk through the claim step-by-step and line-by-line. Prairie States’ “clinical detectives” look for anything that might be inconsistent with the patient’s diagnosis, or with procedures billed by the facility in similar circumstances. Every test, procedure, medication, follow-up and recovery treatment is checked for anomalies or excessive charges.

Critical judgment calls must be made, so the human touch makes all the difference. The nurse’s vast experience and the ability to recognize red flags are essential to an accurate review and assessment. Whether it’s a simple error, plan exclusion, or fraud—having an expert investigate and evaluate each claim is the key.

Bill audit is an extremely effective tool for saving on plan costs. And it’s a service unique to Prairie States.

“When it comes to bill audits and saving our clients and members money, it’s the invaluable experience and expertise offered by our team of seasoned Registered Nurses that makes all the difference,” said Prairie States CEO Felicia Wilhelm. “This personal touch is incomparable to any automated system. Of course, we use some phenomenal data tools to help us do the job. Still, it’s the individual’s adaptability that is crucial to making these extremely important, well-informed decisions. That can often mean a difference worth thousands of dollars.”

About Prairie States

Now celebrating their 30th year, Prairie States delivers the programs, insights and expertise to bend the trend of rising healthcare costs. Paired with a staff of dedicated, informed and responsive people who care about the members they serve, this integrated approach allows us to identify ways to save on costs for employers, without compromising the quality of care for employees and their families. Prairie States provides cutting-edge health benefits administration with a human touch. It’s a difference you’ll notice the very first moment we start working together and one you’ll wonder how you ever did without.


Prairie States Enterprises, Inc. is a third-party health benefits plan administrator that brings industry expertise and a clinical focus to self-insured companies. Our in-house claims administration, health management services, wellness programs, plan analysis and predictive modeling tools result in remarkable and unprecedented cost control for employers. We also provide the most compassionate and personalized level of service for plan members.
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