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Providing Additional Levels of Claims Auditing
McKesson code audit solutions for claims adjudication include ClaimReview®, an add-on module to ClaimCheck®, that introduces a customizable second level of review for claims that usually require manual processing.
ClaimReview identifies problematic billing and coding activities, resulting in additional savings of benefit dollars, lower administrative costs and enhanced data quality.
Ensuring Accurate Data
Using current and historical claims data, ClaimReview continues the data cleanup process started by ClaimCheck, ensuring the most accurate data possible – essential to sound clinical and financial decision making.
Payors can apply edits selectively as well as define the level of action desired (e.g., deny, suspend, replace or monitor) when a potential problem claim is identified. ClaimReview's sophisticated clinical logic and flexible design help payors target such issues as:
- Diagnosis compatibility
- New visit frequency
- Third-party liability
- Multiple or duplicate component billing
Creating Operational Efficiencies
ClaimReview yields substantial efficiencies, as manual utilization review efforts are automated with edits applied consistently across physicians and specialty groups. Specific messages notify reviewers when additional documentation or investigation is needed, and letters can be generated to physicians, speeding up the resolution of problem claims.
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