Solutions
Claims auditing module
Using our real-time adjudication solution, 90-95% of claims are automatically processed based on pre-defined business rules. The other 5-10% require human intervention, as these represent the cases that are unusual, suspicious or the most costly.By filtering out the majority of claims, medical auditors can focus on the small percentage of claims that make the biggest difference.
We provide a system and an interface to efficiently manage this process. The cases are automatically fed in to a web-based system which is monitored by medical auditors. The auditors can quickly analyze the case, provide an immediate decision if possible, or request further information from the practice or patient as required.
