No claim should process without validation
Many factors magnify claims validation complexity including:
- Ever-changing CMS rules
- Confusing and ambiguous payment policies
- Detailed and customized provider contracts
- Over 85,000 diagnosis codes
- Multiple forms of reimbursement
Our pre-payment validation uses predictive scoring with advanced machine learning to systematically analyze all claim types for billing errors. It suggests a hold, pend or deny action. All of this occurs after claims have been adjudicated but prior to payment.
Our post-payment validation process aligns with our pre-payment validation to conduct look-back reviews of claims paid prior to instituting a pre-payment validation process.
Post-payment validation continues to identify claims with errors not appropriate for a pre-pay audit. Certified coding professionals can conduct post-payment audits onsite or remotely.
What makes our Claims Validation unique?
We can validate all professional and facility claims and offer both pre- and post-payment reviews to maximize results. Our validation includes daily predictive scoring to:
- Accurately and quickly identify potential errors
- Flag providers
- Validate charges
- Reduce repeat errors
We cast the widest net to catch fraud, waste, abuse and errors along the payment lifecycle. Applying pre-pay and post-payment validation and audits is more effective. It also reduces provider abrasion and optimizes your results.