Ensure E/M visit level assignment for facility claims
Emergency Department Claims (EDC) Analyzer — Facility: Helps health plans determine fair and consistent levels of facility reimbursement for outpatient emergency department (ED) services. We apply standard cost factors with extended cost factors and patient complexity costs to determine the appropriate visit level.
Identify non-emergent facility claims in the ED setting
Non-Emergent Claims Analyzer: Assesses outpatient ED claims to determine if care could have been provided in a non-emergency setting. It uses the member’s reason for visit, as well as other contributing claim information, to consistently apply prudent layperson guidelines.
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