End-to-end claim review
Our comprehensive suite of solutions is available both pre- and post-pay to catch errors at every step in the claim lifecycle. Our services include:
- Data Mining – Identify claim errors and overpayments related to duplicates, coordination of benefits, billing issues and contract administration.
- Professional Claim Review – Identify coding errors, such as upcoding and unbundling, on professional claims by comparing charges against a medical record.
- Facility Audit – Validate coding and clinical accuracy on inpatient and outpatient facility claims by comparing charges against a medical record.
- Itemized Bill Review – Identify errors on high-dollar inpatient and outpatient claims with a line-by-line review of the itemized bill.
- Hospital Bill Audit – Validate high-dollar inpatient claims against the itemized bill and medical record.
- Short-Stay Billing Validation – Identify ambulatory or outpatient claims incorrectly billed as inpatient.
