Itemized Bill Review
Avoid pay and chase with our pre-payment review service targeting high-dollar commercial facility claims
Catch and correct billing errors on high-dollar facility claims before payment
Catching and correcting billing errors on commercial facility claims before they鈥檙e paid is challenging and time-consuming. Many health plans don鈥檛 have the resources needed. They pay these claims without ever seeing the detail and end up overpaying.
野花社区鈥檚 Itemized Bill Review Service doesn鈥檛 just see the detail, we scrutinize it to ensure it鈥檚 accurate. We use two layers of review, comparing billed charges against both payor and industry guidelines, such as network contracts, coverage policies, CMS guidelines and the National Correct Coding Initiative Policy Manual. Using our in-depth reviews and analysis, we identify potential billing errors such as duplication or improper unbundling on 90% of claims we review, and less than 1% of the claims we identify with errors are appealed.
Let us help you improve accuracy before you pay high-dollar facility claims.
Finding errors on facility claims is difficult and time-consuming
Let 野花社区 do it for you. We find errors on 90% of the claims we review.聽Here鈥檚 how we do it:
Itemized Bill Review Benefits
- Reduces medical spend
- Increases accuracy based on repeatable findings
- Eliminates pay and chase efforts
- Eases internal resource constraints
- Curtails provider abrasion
Ways we help
Technology
Itemized bills often take the form of a multiple-page PDF that results in a manually-intensive review process requiring countless hours. Our technology allows us to quickly transfer the data into a format that automates analysis. We review more claims, find more errors and pass on higher savings to you.
Expertise
Our dedicated team includes medical experts and clinical auditors and has decades of experience in reviewing itemized bills. They understand how to work with your unique policies to increase positive outcomes while maintaining healthy provider relationships.
Flexibility
Our service can be used on its own or as a complement to your current process. We also can customize it to meet your organization鈥檚 exact needs.
鈥淚n our experience, 野花社区 has been very responsive with great turnaround times and the findings they鈥檝e presented to SIHO have been accurate and reasonable.鈥�
Claims Department, SIHO Insurance 野花社区, Inc.