Data analysis software (e.g., ACL) allows us to review 100% of your data. This means we can provide you with lists of specific policies and claims that need to be reviewed and quantify the effects of detected errors.
Duplicate Claims 
Overpayments
Detecting and correcting overpayments is critical to controlling costs. We are able to compare contractual amounts and actual payments to identify overpayments to both care providers and policy holders. We can also identify variances in amounts paid per CPT code.
Claim Processing Review
Unfortunately, some people make mistakes and others aren’t honest. Reviewing your procedures will help to ensure claims are being processed correctly. We can also analyze your claims data to compare physician codes to CPT codes or review claims for exclusionary items per plan code. In addition we can use data analysis software to check claims adjudication or to identify other unusual trends or anomalies.
Deliverables We provide you with the information necessary to understand the identified errors along with suggestions for how to prevent or detect incorrect claim processing and payments. We can also help you develop continuous monitoring procedures to proactively identify these items on a regular basis.
If you're interested in these or other ways we can analyze your data and improve your business, please contact us. At Brown Smith Wallace, we Make a Measurable Difference.
What else should I consider?
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