µç³µÎÞÂë

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.

Ìý

MinimizePre-Payment Waste

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

  • Maximize incremental savingsÌýwith sophisticated cross-claim logic.

  • Increase efficienciesÌýwith automated detection capabilities.
  • Reduce pay and chaseÌýas savings are captured before they are paid.

  • MinimizeÌýimproper payment risk.

  • Access results and statusÌýthrough 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 Networkâ„¢.
    • 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

View all insights

PRODUCT SUPPORT

Need support for
this solution?

Join Community discussions

Find and share knowledge, exchange ideas, and collaborate with peers and µç³µÎÞÂë experts to drive your solutions to success.

Let’s start a conversation

We’re here to help you find out how our services could benefit your organization. Complete the quick form to the right, and someone will reach out to you soon.

Our experts will:

  • Discuss your individual use case and business needs
  • Explain our features, benefits, and services
  • Show how this solution can help achieve your goals

Want more information about our services? Start here.

Thank You

We appreciate your interest in µç³µÎÞÂë. A member of our team will contact you to better understand your needs and discuss potential solutions.

Together, we are accelerating the journey toward improved lives and healthier communities.