FORT WORTH, Texas, April 19, 2021 — CERIS, a division of CorVel Healthcare and a leading national provider of cost containment solutions, now offers a comprehensive prospective claim review services for client firms that pay medical claims. The expanded service produces the most complete and accurate review available for both itemized bills and DRG (diagnostic-related groupings) validation.
“Our itemization review already has the industry’s best track record for correcting billed charges,” noted Corey Albrecht, President of CERIS. “For claims that pay a DRG base rate or an outlier payment and/or have carve-out language, we’re the first firm to deliver a complete package by offering full DRG validation review,” Albrecht remarked.
CERIS’s dual reviews validate coding on the DRG base rate and simultaneously perform an itemization review to identify disallowed charges on the outlier payment. All reviews are completed within prompt payment requirements with this turnkey prepayment review before they’re paid.
CERIS’s independent ownership and amicable, decades-long, relationship with medical providers contribute to its success in obtaining itemized bills and medical records for review. CERIS’s technology reduces provider friction while verifying payment integrity and delivering industry-leading results to health plans and TPAs.
In an industry where insurers are acquiring similar claims review operations, CERIS is unique in that it is independently owned by a 30-year-strong public company, CorVel Corporation. CERIS’s solutions utilize CorVel’s pioneering AI and machine learning for automation and predictive analytics to deliver efficient prepay solutions for payment integrity programs.
CERIS is at the forefront of the transition to prepayment solutions with the ability to review all claim types across commercial and government business.
“CERIS is aligned with CorVel’s long-term view of success, and we’re committed to achieving substantial growth for our payment integrity operations over the coming decade,” said Albrecht. “We’re continually investing in new systems and services to keep our customers on the leading edge of marketplace transformations.”
CERIS, a leader in both prospective and retrospective claims review and repricing, combines clinical expertise and cost containment solutions to ensure the accuracy and transparency in healthcare payments. Accuracy and validation services include itemization review, DRG validation, facility repricing, contract and policy applications, review of implants and devices, and primary payer cost avoidance. Its universal chargemaster contains billions of charge items from more than 97% of the nation’s hospitals, helping to ensure the accuracy and objectivity of each claim review.