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Itemized Bill Review

Avoid pay and chase with our pre-payment review service targeting high-dollar commercial facility claims

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Catch and correct billing errors on high-dollar facility claims before payment

Catching and correcting billing errors on commercial facility claims before they’re paid is challenging and time-consuming. Many health plans don’t have the resources needed. They pay these claims without ever seeing the detail and end up overpaying.

ĤƵ’s Itemized Bill Review Service doesn’t just see the detail, we scrutinize it to ensure it’s accurate. We use two layers of review, comparing billed charges against both payor and industry guidelines, such as network contracts, coverage policies, CMS guidelines and the National Correct Coding Initiative Policy Manual. Using our in-depth reviews and analysis, we identify potential billing errors such as duplication or improper unbundling on 90% of claims we review, and less than 1% of the claims we identify with errors are appealed.

Let us help you improve accuracy before you pay high-dollar facility claims.

Finding errors on facility claims is difficult and time-consuming

Let ĤƵ do it for you. We find errors on 90% of the claims we review. Here’s how we do it:

Itemized Bill Review Benefits

  • Reduces medical spend
  • Increases accuracy based on repeatable findings
  • Eliminates pay and chase efforts
  • Eases internal resource constraints
  • Curtails provider abrasion

Ways we help

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Technology

Itemized bills often take the form of a multiple-page PDF that results in a manually-intensive review process requiring countless hours. Our technology allows us to quickly transfer the data into a format that automates analysis. We review more claims, find more errors and pass on higher savings to you.

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Expertise

Our dedicated team includes medical experts and clinical auditors and has decades of experience in reviewing itemized bills. They understand how to work with your unique policies to increase positive outcomes while maintaining healthy provider relationships.

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Flexibility

Our service can be used on its own or as a complement to your current process. We also can customize it to meet your organization’s exact needs.

“In our experience, ĤƵ has been very responsive with great turnaround times and the findings they’ve presented to SIHO have been accurate and reasonable.”

Claims Department, SIHO Insurance ĤƵ, Inc.

Contact us today for more information on Itemized Bill Review.