Approximately 95% of hospital admissions are in-network. Therefore, it is essential that primary and stop-loss payers have the right tools to navigate the complex demands of the in-network environment to affect the best financial and quality outcomes for special cases.
Health Claim Review® uses 4 distinct methods to help our clients achieve inpatient cost savings. These methods may be used alone or in combination to meet case needs and customer requirements. In patient bill review techniques may be applied to outpatient facility repricing as well.
- Line Charge Verification
- Physician Specialist Utilization & Quality Audit
- Usual & Customary Repricing
- DRG Medical Record Validation