DRG Claims Management
DRG Claims Management specializes in identifying overpayments for health plans and payers by employing a coding guideline-based model. The service includes physician review for clinical validation of diagnoses, ensuring collaboration with provider hospitals. This approach not only minimizes denials and appeals but also delivers verified savings through enhanced coding compliance.
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Top DRG Claims Management Features
- Clinical validation findings
- Provider-payer collaboration model
- Coding guideline-based approach
- Physician review team integration
- Unsubstantiated diagnosis identification
- Customized auditing solutions
- Overpayment identification focus
- Enhanced coding compliance
- Denial reduction strategies
- Appeals management support
- Verified savings tracking
- Real-time audit reporting
- Comprehensive claims analysis
- Tailored training programs
- Regulatory compliance assurance
- Risk assessment tools
- Data-driven decision support
- Workflow optimization features
- User-friendly interface
- Continuous improvement feedback loop
