Healthcare

True accuracy requires solutions across the payment continuum

Prospective claims accuracy Retrospective claims accuracy Learn more

Analytics-driven claims accuracy

Prospective Retrospective
  • Who has liability for this claim?
  • Does any other party share in the liability?
  • Are all value-based reimbursement criteria being met?
  • Was the claim coded correctly?
  • Are codes consistent with payment policy?
  • Are providers complying with payment policies?
  • Is the claim submitted in accordance with the contract terms?
  • How should this claim be calculated?
  • Was care delivered in accordance with industry and payer guidelines?
  • Does chart documentation support the submitted claim?
  • Are there patterns of abuse and waste?
  • Is the provider an outlier compared to other providers?