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We account for every dollar on every claim.
Prepay
We have nearly three decades of experience providing prepay solutions. Our integrated analysis digs deep to identify issues in the claims lifecycle and address them before payments are processed.
Post Pay
This traditional approach needs a solid line of sight to assess integrity. Our approach is to holistically review claim payments for inaccuracies and drive cost containment for our clients.
Prepay
Post Pay
Itemized Bill Review
Completely flexible to your needs, we partner with you to better your itemized review—whether done in prepay, post pay or both.
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Prepay
Post Pay
DRG Validation
We ensure a comprehensive coding review and clinical validation to ensure accurate reimbursement. The codes billed are accurate or corrected when compared to patients’ medical records. Our experienced team of reviewers are guided by our Medical Director and use enhanced technology to ensure all the right corrections are made in a timely manner.
We handle immediate referrals within 5 business days.
Prepay
Professional Claim Review
Available for prepay, these reviews help confirm claim coding with documentation and search tools that dig deeper for various types of reductions. Our Coding Auditors have an average 11 years of experience and our Nurses have an average of 21 years of experience.
Post Pay
Hospital Bill Audit
Our most in-depth review, Hospital Bill Audit is a thorough evaluation of all potential records—from itemized bills and medical records to nurse and operative notes.
Complex implementations within 90 days.
Prepay
Post Pay
Out of Network
Going out of network can significantly increase the cost of care. We reprice these claims and clinically review every charge for complete accuracy. This thorough analysis brings significant savings with little to no appeals.
We offer Specialty Reviews too.
Implant Review
We provide full clinical application and appropriateness review, repricing implants with 62% average savings.
Transplant Review
We take a global approach to this sensitive topic by pulling all medical bills together to review, correct, and re-allocate payments for the entire case.
