ClaimCorrect

What is ClaimCorrect?

Claim delay and denial is a growing concern in the Healthcare industry. Providers and payers are looking for methods to reduce costs while maitaining 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.

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

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	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	View an interactive online demo of ClaimCorrect to see how the edits are applied to a claim.

Need More Information?

For more information or to set up a ClaimCorrect account, please call our toll-free number (below), or email us at Info@PRSUroSC.com.