Administrative Compliance

Analysis of prepaid or postpaid claims data to determine if services were provided based on contractual, policy, and procedural standards.

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  • Non-covered Benefits
  • Duplicate Payments
  • Contract Compliance
  • Coordination of Benefits
  • Third Party Liability
  • Eligibility Determination
  • Complex Payment Terms
  • Subrogation

Lines of Services

Provides a variety of inpatient and outpatient services, pharmacy, long term acute care, skilled nursing facilities (SNFs) and physician services.

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  • Acute Inpatient Hospitals
  • Outpatient Services
  • Physician Services
  • Ancillary Services
  • Durable Medical Equipment
  • Inpatient Rehab Services
  • Inpatient Psych Services
  • Skilled Nursing Facilities
  • Home Healthcare Services
  • Dental and Vision Services
  • Pharmacy
  • Long Term Acute Care (LTAC)

Review Types

Review a host of services, including but not limited to medical chart review, DRG validation and medical necessity of admission.

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  • Medical Chart Review
  • DRG Validation
  • Medical Necessity of Admission
  • Appropriateness of Billing
  • Adherence to Treatment Plan
  • Correct Coding
  • Level of Service