Summary of the rules for treatment & reimbursement

Proto-Link™ rules cover all 51 jurisdictions:

• Adjudicates health care treatment for drug utilization, diagnostic testing, physical medicine, surgery, and other categories
• Provides clinical reasoning for medical decisions to resolve disputes among provider, payer, and patient 
• Evaluates all aspects of patient stage recovery: diagnosis, education, informed decision making, treatment parameter duration, active interventions, positive patient
• Tackles the treatment of physical conditions that occur with the greatest frequency, or which require the most expensive treatments 
• Covers all phases of an injury; acute, subacute, and chronic to ensure the proper treatments during the correct clinical stage
• Identifies red flags that may suggest the presence of serious underlying medical conditions 
• State mandated provider specialty and licensing requirements for specific products and services to prevent unqualified medical treatment
• State mandated coding requirements for products and service as well as provider specialties to ensure proper coding 
• State mandated non-reimbursable codes to flag improper billing 
• State mandated maximum reimbursement allowances to reduce costs 
• State mandated reductions in maximum allowable reimbursement based on modifiers/provider specialty for proper billing  
• State mandated facility-specific coding and billing requirements to ensure proper treatment/billing 
• CMS - National Correct Coding Initiatives (NCCI) to reduce excessive/incorrect products/services