ClaimDOC' s comprehensive line-by-line auditing uncovers errors that basic repricing and auto-adjudication does not catch, leading to greater savings to health plans and beneficiaries.
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Audit Spotlight
Cynthia Swanson
RN, CPC, CEMC, CHC, CPMA, Senior Audit Manager
Background
ClaimDOC's comprehensive line-by-line auditing uncovers errors that basic repricing and auto-adjudication do not catch, leading to greater savings to health plans and beneficiaries. Our audit team analyzes all types of healthcare claims for a variety of potential concerns including excessive usual and customary charges, duplication of claims, correct coding edits, unbundling of services, and others. Our claims review is not intended to impact care decisions or medical practice.
Case Scenario
Member was admitted to the hospital for elective spinal correction surgery, resulting in a four-day hospital stay. The hospital claim and charges submitted to insurance totaled $321,691.21. The primary diagnosis reported on the claim was degeneration of the thoracic spine. Read more..
Client Savings
Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.
1. Cleveland, OH
Six-day hospital stay for treatment of convulsions
Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.
Member Experience
Feedback from a Member
I was very unruly and frustrated at the beginning of our call. Emmanuel took his time to make sure he explained everything to me, so I could understand each claim and what it was for. I'm new to this insurance and I will enjoy it, even more, knowing ClaimDOC has member advocates like Emmanuel available to help. I work in customer service so shame on me for being a horrible customer but thank you Emmanual for being so nice and helpful.
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ClaimDOC, 3200 Westown Parkway, West Des Moines, IA 50266, 1-888-330-7295
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