Claims Management and Review

At Health Claims Management Group, our working knowledge and insight are at your disposal. We can help you and your organization control costs and manage utilization through medical claims management and review.

Our review process is designed to verify that the care and treatment rendered is clinically appropriate, meets accepted medical standards of care, and coding and reporting guidelines.

Examples of our thorough review process include:

• Is the diagnosis consistent with the procedure(s) rendered?
• Do national coding guidelines permit this procedure to be billed separately?
• Has this procedure previously been reported?
• Does the number of units of a service exceed the medical standard of care?
• Does the diagnosis lack a clinical, definitive connection to the procedure?
• Is there a conflict between different service codes used?
• Are the codes utilized valid?

Our review can spot coding and billing errors which result in costly overpayments to providers. This process leads to correct coding, billing, and reimbursement.