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What is
™ClaimCorrect?
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Claim delay and denial is a growing concern in the Healthcare industry.
Providers and payers are looking for methods to reduce costs while maintaining a system
of quality control checks based on medical necessity and benefits purchased. This, HIPAA
compliant, dynamic web based application uses a sophisticated and extensive database
to analyze claims relative to the rules established by commercial and governmental third
party payers. Some of ClaimCorrect's edits include LMRP, CCI, age, gender, modifiers, and
global services for HCPCS, ICD9 and CPT.
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In addition to providing claims analysis prior to submission, the system will
allow EOB review to track payer performance on contracts and profitability analysis. Reports
available will provide administrators the ability to monitor provider practice patterns and
comparative data sets will automatically alert providers to billing patterns outside the norm
for the specialty.
The reports include provider analysis for:
- Claim Errors & Alerts
- Audit & Compliance
- Utilization & Patterns of Care
- Provider Productivity
In addition to analyzing provider data, the
application allows the user to compare their coding trends with
those of physicians of the same specialty. |
How Does it Work?
This interactive web-based application is available through
the Internet, utilizing your current Internet Service Provider (ISP) by importing standard NSF claim records.
Through the specialized database, combined with proprietary technology and
applications, ClaimCorrect addresses three important areas, Accurate Claims, Fraud and Abuse
Compliance and Revenue Management.
ClaimCorrect provides a cost-effective way to self-monitor
healthcare claims for errors or possible fraudulent billing patterns. By utilizing
the Correct Coding Initiative (CCI) Rules, as developed by HCFA, Local
Medicare Review Policies (LMRP), edits for age and gender, as well as
other comprehensive edits, ClaimCorrect performs a line item audit of each
claim submitted to payers. The claims are processed through an Oracle
rules-based engine to determine accuracy and compliance. The CCI rules, LMRP, and CPT-4
/ ICD-9 codes are updated electronically as soon as they are released so
that the physician's claims are always processed with the most current
information. Moreover, payer-specific rules for commercial insurance companies and Workers'
Compensation are continually updated on a daily basis.
Because ClaimCorrect is a web-based application, when the system is updated,
you are instantly updated with the latest information. No need to install software or perform updates from
a download, floppy disk, or CD-ROM.
Revenue management opportunities are available through a
suite of ClaimCorrect reports that alert the physician when coding errors have
been identified. In addition the application, through a series of graphs
and reports, shows potential down coding and coding outliers, as compared
to the provider's peers within the same specialty.
Take a Closer Look
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 Click the links below for a closer look
at the application. |
| Link |
Description |
| Audit
and Compliance |
This suite of revenue analysis reports track physician
productivity and coding compliance compared to specific specialty or
diagnosis peer data. |
| Utilization
& Patterns of Care |
The Utilization reports throughout the application allow the
provider to examine ICD-9/CPT-4 crosswalk coding patterns. For
comparative purposes, Peer Utilization Analysis is available for the
same specialty as the provider. Patterns of Care tracks the
provider's usage of specific codes and presents them for review in
graphic form and custom reports. |
| Productivity |
This suite of productivity reports track provider productivity
based on Total Gross Charges, and CPT-4/ICD-9 usage. |
| Reports List
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Review a brief description of
each report available through ClaimCorrect. |
| Frequently
Asked Questions |
Review answers to the most commonly asked questions by our
users. |
| Interactive Demo |
For more
information or to set up a ClaimCorrect account, please call our toll-free
number (303) 451-9659, or email us at Info@ExaMedIT.com.
[Back to
ExaMedIT] |
Version 4.0 Last Update: 12-10-2003
Copyright © 2003 ExaMedIT, Inc. All Rights Reserved.
CPT- Copyright © American Medical Association
ICD - Copyright © World Health Organization
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