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Average Ratings 0 Ratings
Description
It is accurate to assert that "not all DRG vendors are equal." Although their marketing strategies may be similar, these vendors generally fall into two categories: those that cater primarily to provider hospitals and those focused on detecting overpayments for health plans and payers. Much like how attorneys often concentrate on either defense or plaintiff cases, auditing vendors tend to specialize in the distinct needs, cultures, and priorities of their respective clients. Within the realm of payer-focused vendors, a diverse array of strategies for DRG auditing and overpayment detection exists. Our service offerings also include a dedicated physician review team that generates clinical validation findings, specifically addressing cases where identified issues stem from unsubstantiated clinical diagnoses made by treating physicians, which goes beyond the capabilities of coders. Our findings consistently demonstrate that our coding compliance model yields verified savings, contributing to enhanced financial efficiency for healthcare providers. Thus, selecting the right vendor can significantly impact the financial health of both hospitals and payers alike.
Description
To mitigate potential risks, the Centers for Medicare and Medicaid Services (CMS) have instituted guidelines to ensure the validation of their networks. Given that Pharmacy Benefit Managers (PBMs) are significantly impacted by the risk assessment process, the demand for precise and actionable insights has reached unprecedented levels. The LexisNexis Provider Integrity Scan streamlines a variety of provider verification processes and offers continuous monitoring by cross-referencing numerous files and lists, while also delivering automatic alerts for numerous high-risk factors. This tool is proficient in screening and verifying providers both before and after enrollment, aiming to uncover and thwart criminal activities effectively. By identifying potentially fraudulent providers and businesses involved in health-related programs, the LexisNexis Provider Integrity Scan serves to lower costs for health care payers and PBMs alike. Our innovative solution empowers users to effectively conduct multiple searches and access crucial information, enhancing their operational efficiency and security. This comprehensive approach not only safeguards the integrity of health care programs but also fosters a more reliable health care environment.
API Access
Has API
API Access
Has API
Integrations
XML
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
DRG Claims Management
Founded
2009
Country
United States
Website
www.drgclaims.com/solutions/
Vendor Details
Company Name
LexisNexis
Founded
1970
Country
United States
Website
risk.lexisnexis.com/products/provider-integrity-scan