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Most payment integrity solutions rely on automation of published edits and policies, leaving significant errors behind.
Our Pre-Payment Clinical Review Services combine automation with expert clinical review. Between analysis and payment, we add a level of human clinical 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.
Here are four ways COVID-19 has changed the billing landscape and what we can expect for the future.
We involve clinicians at every step, including daily claim reviews and provider appeal support.
We integrate clinical review to confirm complex issues prior to recommendation.
Four decades of pre-pay experience – most claims returned within 24 hours.
We contract with 1.2 million providers; with an appeal rate of 3%, we minimize provider abrasion.
With our long-tenured focus on non-contracted claims, we see the most creative billing schemes.
We are HITRUST certified with nearly 300 payors depending on us for pre-payment integrity services.
Better payment accuracy means more affordable healthcare and a stronger provider-plan-patient relationship.