The No Surprises Act and the IDR process present unique challenges for payors and providers – from an inefficient portal to a shortage of IDR entities and constantly changing rules. In this blog post, we discuss the top 8 challenges we’ve encountered and what you can do to address them.
As COVID-19, RSV and other infectious diseases have spread over the recent years, waste and abuse in healthcare claims billing relating to these conditions has increased. What is your payment integrity vendor doing to address this growing trend?
As a part of Claritev’s Payment Integrity service, we review claims to ensure there are no billing errors and that the charges make sense. When we find mistakes or suspicious charges, we investigate. This blog details findings that left us shaking our heads.
Medical bills are a top stressor among patients and most agree that dealing with them is highly stressful and inconvenient. In fact, 56% of patients report that generally medical bills are a leading source of stress. Figuring out these bills is also often hard, which leads to confusion on top of the anxiety about the cost itself. Therefore, balance bills can add another source of stress.
Data Mining, a post-payment payment integrity service, detects errant medical claims in sets of data. Errant claims typically include duplicate payments and claims with billings issues that lead to overpayments. MultiPlan identifies errant claims by scouring the data. We use artificial intelligence, including machine learning and algorithms, to identify incorrectly paid claims and anomalies in the data. We also have subject matter experts on our data mining team review all findings to confirm the findings of the technology. All findings are presented to our clients for approvals.
Claritev summarizes the FAQ issued by the Biden administration on October 6, 2023 as well as the reopening of the IDR portal.
Claritev summarizes changes to NSA regulations and guidance as a result of rulings in TMA3 and AAMS.
A federal court in Texas recently ruled in favor of the Texas Medical Association in its fourth lawsuit challenging the No Surprises Act. Claritev explains the ruling.
As a part of Claritev’s Payment Integrity service, we review claims to ensure there are no billing errors and that the charges make sense. When we find mistakes or suspicious charges, we investigate. This blog details our eye-popping findings.
To tackle the problem of out-of-network charges, Claritev developed our Data iSight pricing methodology. Unlike Usual and Customary (U&C) or Medicare-based repricing solutions, our methodology recommends reductions using both a cost-up approach (for facility claims) and median reimbursement levels (for practitioner claims) to achieve maximum defensibility, wide provider acceptance, and savings of 61%-81% off billed charges.