O4 Detail Hero Banner

Emergency Department Claim Analyzers

Control rising emergency outpatient facility and outpatient professional costs with automated, consistent and defensible E/M coding evaluation.

O4 50-50 Content Block

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.

Download fact sheet
O4 50-50 Content Block

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.

Learn more

Add Claims Coding Solution to your payment integrity portfolio today.

O4 Simple Cards

Extend your editing capabilities

O4 Simple Card
Fact sheet

Specialty Rx Analytic Suite

Implement specific edits for specialty medications.

O4 Simple Card

Claims Edit System

Solve editing challenges of all sizes.