Software

Pre-Payment Insight & Review

An analytics and methodology-driven prepayment medical record and claims review solution for TPAs and payers that want to broadly view billing activity, identify improper payments before they are paid, and reduce waste in the payment process.

 

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MinimizePre-Payment Waste

  • Identify improper claims, allowing an opportunity to correct them and deliver medical cost savings.

  • Maximize incremental savings with sophisticated cross-claim logic.

  • Increase efficiencies with automated detection capabilities.
  • Reduce pay and chase as savings are captured before they are paid.

  • Minimize improper payment risk.

  • Access results and status through our client portal to identify gaps in the claim payment process.

Increase Transparency and Minimize Costs

  • Expert payment integrity insights

    • Leverage the breadth of information available on our Intelligent Healthcare Network™.
    • Enhance your approach to preventing unnecessary losses with our clinical experts and certified coders that evaluate flagged claims for potential risk, and provide expert insights.
    • Reduce provider abrasion with an expert staff that reviews flagged claims and only selects those for medical record review that have highest potential for savings.

  • Medical record review service

    • Identify claims for review with powerful data-driven analytics and industry sourced, proprietary claim screening logic combined with our expert triage process.
    • Identify new and emerging abnormal claims submission scenarios.
    • Take advantage of our experts that deliver detailed documentation of review findings and provide support through the appeal process.

  • Supplemental code edit service

    • Access continuously updated edits that identify code edit savings often missed by primary code edit software.
    • Depend on customized code edits that act as a safety net for primary code edit solutions that may not be fully up-to-date.
    • Ensure edits are current with our Software as a Service (SaaS) approach.

Our outcomes

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Fact Sheet

Access Hundreds of Payers for Real-Time Eligibility, Benefits Data

Fact Sheet

Access Hundreds of Payers for Real-Time Eligibility, Benefits Data

Learn how our RESTful Eligibility API can connect you to 2,100-plus healthcare payers via a simple and cost-efficient implementation.

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Fact Sheet

Reduce Provider Abrasion and Resource Allocation with Coding Advisor

Fact Sheet

Reduce Provider Abrasion and Resource Allocation with Coding Advisor

Learn how Coding Advisor can help you avoid provider abrasion while saving on high-volume, low-cost claims.

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On-demand Webinar

Coordination of Benefits: A Line of Defense Against Overpayments

On-demand Webinar

Coordination of Benefits: A Line of Defense Against Overpayments

Explore the benefits of developing and augmenting a first line of defense against overpayments with a multifaceted approach to Coordination of Benefits (COB).

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