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Most medical payment integrity solutions rely on automation of published edits and policies, leaving significant errors behind. MultiPlan’s Medical Payment Integrity service combines automation with expert clinical review. Between analysis and payment, we add a level of human expertise to examine claims where appropriate. This complements MultiPlan’s robust analytical programs by targeting complex issues such as contradictory or overlapping services and suspect billing patterns that are generally not addressed by computer alone.
Our analysis of hundreds of millions of paid commercial claims from a variety of payors proves that even when sophisticated editing is in place, MultiPlan’s Payment Integrity “factors” find significant additional opportunities for savings through removal of inappropriately billed charges.
On average, only 15% of these edits are National Correct Coding Initiative (NCCI) edits missed by the payors’ systems while the vast majority are overpayments from inadvertent or exploited loopholes not easily addressed in standardized coding approaches.
Check out some of the crazier billings errors we’ve caught:
MultiPlan brings a cost management heritage to medical payment integrity. We know payment integrity, we know providers, and we know pre-payment. Let us take your historically retroactive process upstream, and ensure that lost claims savings no longer go unnoticed.