Advanced Code Editing
A proactive approach that combines technology with human expertise to help mitigate improper charges and support payment accuracy.
Coding Accuracy
Payment Integrity
Taking payment accuracy beyond simple claims editing to help drive savings and minimize provider abrasion.
The most effective way to handle complex payment issues is to spot the errors before claims are paid.
Claritev’s Advanced Code Editing solution combines automated technology and human expertise to help identify claim lines with coding issues, so that payers can deny improper charges prior to payment in an effort to prevent pay-and-chase scenarios.
The result? Potential pre-payment medical cost reduction on a client’s in- and out-of-network claims with minimal pushback.
Making Our Impact Clear.
5–6%
Average Savings in the
Primary Position
1–3%
Incremental Average Savings in the Non-Primary Position
<2%
Disputes on Corrected
Charges
24–48
Hours
Claims Turnaround Time
Efficient solutions for payers and providers.
Claritev’s Advanced Code Editing uses our payment integrity analytics, comprising rules for over 30 million code combinations across 90 service areas. Issues flagged with very high confidence are immediately returned to the client, while all others are viewed by a clinician or coder to confirm whether the issue is appropriate for pre-payment correction.
Errors identified include:
Improper use of modifiers and overrides
Overlapping procedures
Procedures dependent on diagnoses
To reduce potential provider abrasion, our clinical experts work to verify complex results. This helps ensure our edits are appropriate and more likely to be accepted by providers.
We also support transparency by giving providers access to our online portal, where they can review explanations of edits or contact us with questions. We apply the same Advanced Code Editing to claims from more than 1 million providers in our own networks.
A clear view of the value Claritev creates.
We involve clinicians at every step, including daily claim reviews and provider appeal support.
We integrate clinical review to confirm complex issues prior to recommendation.
Our extensive experience with out-of-network and non-contracted claims allows us to see new and creative billing schemes.
We are HIT RUST certified with nearly 300 payers depending on us for pre-payment integrity services.
Engaging insights
Claritev insights, resources, and case studies.
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How can Claritev help strengthen your payment accuracy operations?
Learn how Claritev can bring payment integrity into focus, helping to deliver greater accuracy and transparency.
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