CERIS White Paper Highlights Advantages of Prepayment Claims Review

August 16, 2022


Company is Leader in Payment Integrity Solutions

FORT WORTH, Texas, Aug. 16, 2022  — CERIS, a CorVel company, and a leader in both pre and post-pay health care claims review today announced a newly published white paper on payment integrity that urges health payers to consider a pre-payment claims review strategy while outlining the challenges and benefits of doing so.

The white paper notes the advantages of undertaking such reviews before money changes hands. Among them:

  • It can take months to reverse an incorrectly paid claim
  • Payers don’t usually recover all money improperly paid as the result of a post-payment review
  • Reviews of disputed claims often require a time-consuming appeals process
  • Pre-payment reviews avoid “provider abrasion” by paying the claim correctly the first time

In instances where CERIS has provided pre-payment claims reviews, the average savings per claim can be as high as $9,000, while the appeals rate of claims can drop from 10% to 3%.

“Given 97% of all negotiated hospital claims contain at least one charge error, switching to pre-payment review can avoid numerous pain points that come with undertaking post payment claim reviews and claw backs,” said CERIS President Greg Dorn.

The white paper on payment integrity may be downloaded here.

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 proprietary 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.

Read the full press release here. 

Let's partner to a clear path to greater accuracy and cost savings.

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