Turning the Tables on Payment Errors
Alivia’s advanced payment accuracy models, developed in FWA Finder™, are pivotal in identifying claim payments with high probability of inaccuracy or improper payment. This includes DRG Coding and Validation, Medical Necessity, Itemized Bill Review, and Payment Analytics to ensure all claim types and services billed are supported and paid appropriately.
Relentless Pursuit of Every Discrepancy in DRG Coding & Medical Necessity
DRG Coding and Validation Reviews
Identification of high-risk DRG claims, selection file generation, medical record requests, and thorough claim validation by clinical and coding experts. Errors lead to documentation, code adjustments, and recovery actions on behalf of the health plan.
Medical Necessity Reviews
Identification of claims likely lacking medical necessity, followed by detailed clinical review of the medical record to confirm the service and validity of the billed claim, with similar steps taken for error documentation and recovery.
Itemized Bill Reviews
Identification of high dollar inpatient facility claims to confirm individual billed items are eligible for reimbursement based on all charges billed on each date of service. Line level errors lead to documentation, billing adjustments, and recovery actions on behalf of the health plan.
Team of experts
Coding Auditors CCS, CIC, CPC Certified coding review experts
Clinical Auditors RN, LPN Licensed medical review experts
Claim Recovery Specialists Claim billing & recovery experts
Uncovered payment opportunities others could not find.”
Market focus
Whether you’re a health plan / payer, regulator or investigator, we provide you with seamless analytics solutions that ensure healthcare payment accuracy swiftly and effectively.
Want to see how you can finally achieve healthcare payment integrity?
