ACTION MEDICAL MANAGEMENT

In January 2017, Action Claims Administrators (ACA) added Action Medical Management (AMM) as a subsidiary for the purpose of reviewing medical bills for state fee schedule reductions as well as applying PPO contracted discounts.

AMM utilizes specialized software that matches the CPT Codes within a medical bill to the fee schedule of the jurisdictional state to determine the allowable amount payable for each medical service.  Most states have fee schedules; however, for the jurisdictions that do not, the CPT codes are matched to Usual & Customary, which is known as U&C and is similar to a fee schedule, but is not mandated by Statute and is therefore not binding.  After Fee Schedule or U&C discounts are applied, the medical bills are often subject to PPO discounts.  A PPO is a Preferred Provider Organization which is also known as a Network.  The providers of these Networks contract with medical service providers to obtain discounts above and beyond Fee Schedule or U&C.  The Network providers are remunerated by receiving a percentage of the contracted discount.  Once all discounts are taken, an Explanation of Review (EOR) is produced by AMM and is mailed to the medical providers with the check issued as payment of services.