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.
AUG 2020 | Get the latest from the best RBP advocates and auditors
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 does 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 delivery of newborn by cesarean section, resulting in a three-day hospital stay. The hospital claim and charges submitted to insurance totaled $96,684.88. The primary diagnosis reported on the claim was maternal care for abnormal presentation of an infant. 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.
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
Last week I was trying to contact multiple companies over the phone and online, none of them connected me with a real person right away. I was either placed in a queue with a long wait time or was told by an automated service to wait for a callback. I am so thankful to have a direct number to my ClaimDOC Member Advocate Katy. She makes my life so much easier. I’ve said it many times, but I am so appreciative to have direct access to an advocate to answer my questions and resolve issues. Thank you ClaimDOC!
We've updated our website!
Whether you're an Employer, Provider, Broker, Stop Loss Carrier, or Member, get valuable information 24/7 by visiting www.claim-doc.com.
You received this email because you signed up on our website or made a purchase.
ClaimDOC, 3200 Westown Parkway, West Des Moines, IA 50266, 1-888-330-7295
.png?upscale=true&width=260&upscale=true&name=Audit%20Spotlight%20(1).png)
