outlier providers exhibiting better accuracy
An analytics and sequenced process-driven billing solution for payers that want to identify billing outliers, change provider behavior, and reduce overpayments of low-dollar, high-volume claims.Contact Us
Manage Healthcare Costs
Address losses on high volume low dollar claims.
Decrease provider abrasion through a collaborative solution delivering targeted messaging and educational data insights.
Drive positive change in billing abnormalities to help reduce mistaken claim submissions.
Help reduce E/M coding errors by educating physicians and their billing staff.
Increase medical cost savings for E/M services with provider self-auditing and coding validation.
Decrease the need for lengthy, costly, and abrasive audit activities.
Change Overbilling Behavior
- Identify coding outliers, comparing to the norm with peer analysis.
- Establish baselines using a one year billing history compared to the billions of claims we process each year.
- Benchmark provider billing behavior with advanced data analytics.
Educational outreach campaigns
- Leverage real-time or next day targeted messages to alert personnel of their E/M outlier billing pattern based on a peer-to-peer analysis for claims processed through our Intelligent Healthcare Network.
- Provide important program information with proactive messages that prompt providers to make corrections and request self-validation of the original coding before resubmitting the claim.
- Educate providers and staff on billing policies with outlier reports, outreach phone calls, and scheduled office visits from Chane Healthcare experts.
Validation and action
- Allow Change Healthcare to monitor and evaluate program adoption, and conduct probe audits on those outlier providers whose behavior has not yet changed.
- Build lines of communication between payer and provider with an inclusive approach of education, outreach, and collaboration that rivals traditional post pay programs.
- Depend on Change Healthcare to prepare documentation, case summary, and action plan for the payer SIU team.
Providing Measurable Value
avg. decrease in overbillings
PMPY medical cost savings