True accuracy requires solutions across the payment continuumProspective claims accuracy Retrospective claims accuracy Learn more
Analytics-driven claims accuracyProspective 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?