Medical Claims Compliance®

Medical Claims Compliance®

   Analyze Medical Records Prior to Submission

Reduces Claim Denials and Reviews, Increases Cash Flow, and Staff Productivity

An astonishing 30 percent of medical claims are rejected on first submission. The more claims rejected, the more likely an organization can be targeted for an audit.

Medical Claims Compliance takes an innovative approach to medical record analysis by combining six major functions:

  • Code Integrity Rules including ICD Tagger, CPT® Tagger, and HCPCS Tagger
  • Governance mapping
  • Validation and cross checking
  • Enriched content mapping solution
  • Machine Aided Indexing
  • Natural language processing

Comparing these key data sets provides a detailed evaluation of each record, including:

  • All salient patient information
  • Key medical facts & taxonomy
  • Procedure notes
  • Claim Submission Form

This produces a highly accurate medical claim that has been thoroughly reviewed prior to submission, resulting in a significant reduction in claim denial and review, and increased cash flow and staff productivity. Medical Claims Compliance allows health care organizations to focus on providing high-quality healthcare services to their patients.

  Multiple Code Data Sets Automatically Checked

 

Medical Claims Compliance checks each submission and produces detailed reports in seven specific areas:

  • Code set and modifier validation
  • NCCI verification
  • Correct fee capture
  • LCD/NCD compliant usage
  • Medically Unlikely Edits (MUE) checked
  • Form 1500 data element compliance
  • Correct RVU
  • Global period eligibility

  Customer Value Proposition

 

  • Search and analyze medical records, including provider and procedure notes
  • Web-based cloud storage/access to all medical transactions
  • Real-time database updates
  • No installation or initiation fees
  • All inclusive application…. no add-on modules or transaction charges
  • Simple, easy to understand annual subscription pricing

Code Integrity Rules

 

  • ICD Tagger: effectively extracts diagnoses and provides highly relevant coding suggestions
  • CPT® Tagger: searches and analyzes physicians' notes to retrieve accurate procedure codes
  • HCPCS Tagger: identifies the appropriate codes for products, supplies, and services used during the patient encounter