DRG Validation Reviews
Ensuring Appropriate Reimbursement Leveraging Claim Analyzing Technology for Accurate & Consistent Results
Solutions Built for Payers
DRG Validation Tools offer analysts pre-screen rules designed to select claims best suited to your unique review programs. Paired with Natural Language Processing technology, our solutions empower the review workflow with auto-extracted insights for quick validation and determination.
The platform allows you to keep tabs on productivity and workflow efficiencies, giving you the ability to adapt to claim needs quickly and gain insight into where your workforce should focus their attention.
Each plan and provider have different needs, and our platform implements pre-built industry edits and pre-screen rules that continually improve to help meet those needs. Clients get complete control over each rule and edit.
We’re delivering results with 98% accuracy in 20 minutes on average with increased compliance and quality. Through interactive dashboards, reporting and closed-loop communications, you’ll see repeatable results no matter the complexity of each review.
In order to expedite the recovery of unsupported claims and limit disputes, communication between the provider and payer is key. With lower appear rates and consistent communication, you’ll strengthen provider relationships.
Go Beyond Industry Standards
Our unique combination of machine-learning technology, natural language processing and qualified claim experts enables accurate, consistent and timely DRG reviews while delivering flexibility, transparency and control over the entire process.
Simplified Document Retrieval
Client-Controlled at Every Stage
Experience smarter software adaptions that can be implemented as an in-house software solution, outsourced service or any combination of the two. No matter the model, payers retain complete control over the review process.
Workflow controls that route claims to the appropriate team member
Built-in DRG calculation for every claim
Consistent denials that reduce provider appeals over time
Supporting pre-pay and post-pay reviews
Out of the box NLP data-extractions streamline claim determinations
Real Results in Real Time
See how we saved this Blues Plan $30,518.58 (73%) on an inaccurate sepsis diagnosis using our hybrid engagement model.