Identify billing issues and educate providers
We start by analyzing claims to identify billing practices that providers may need help with. Then we determine the most effective way to educate that provider.
Once our education is in place, we measure incremental billing trends to see how effective the education is. This also gives a complete picture of program impact.
We focus on highly utilized providers and providers with multiple coding errors. We further identify providers likely to respond to education. And we cluster provider data to suggest locations for expos and on-sites.
Education tactics based on three key concepts
Provider Education offers more than 200 education campaigns — and they’re never one-size-fits-all. We offer a range of high-touch and low-touch tactics, designed around three important concepts for successful billing behavior change:
- Unbundling: lessens the frequency of billing component services alongside services they should not be bundled with.
- Upcoding: reduces how often higher severity level codes are distributed.
- Missing support: cuts down on billing codes that don’t have the proper support.
Discover the results of changing provider billing behavior
Decrease in medical record request rate
Decrease in appeal rate
Fall in denial rate
For Provider Education, compared to network average of 31
"We've heard effusive praise on the impact of the payment integrity focus and tools being made available to our providers"
-Vice President of a Health Plan
"Provider Education saves time, money and fustration for both payers and providers"
-State Medical Association Member