CAVO Payer 2019-06-03T10:24:21-06:00
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An Enterprise Medical Record Review Platform

Directly access EMR data and images

Digitally review, sum, sort, and share IBs

Immediately decrease cost containment spends

Expand audits

Increase productivity by 300+%

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What is CAVO Payer?

Technology platform streamlining medical record reviews

Organize cases

Into a single repository of data – including images – accessible for a multitude of use cases

Instantly search

And find medical record information to efficiently make decisions

Articulate findings

With easily created review/findings packets providing only decision-relevant details

Solves common challenges:

  • Case inorganization

  • Lack of resources

  • Evolving review thresholds

  • Administrative costs

  • Multi-platforms and siloed reporting

About Searching Medical Records

  • Type search terms or phrases

  • Utilize pre-defined searches

  • Create and sort by tags

  • Receive relevance-ranked results

LEARN MORE

What if your health plan could…

  • Increase payment integrity productivity by 300+%

  • Turn outliers into profit centers

  • Immediately decrease cost containment spends

  • Directly access EMR data and images

With CAVO, you can.

How CAVO Payer Works

AGGREGATES

Intakes medical record documents into a single repository

ANSWERS

Delivers searchable platform of medical record data – including images

ASSEMBLES

Streamline findings summaries with highlight and annotate tools 

ANALYZES

Expand medical record review reporting, including staff productivity

AUTOMATES

Leverage CAVO to create/enhance machine learning and NLP

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Health plans leverage our medical record review platform for immediate ROI in areas including:

Medical Necessity

  • Leverages clinical time by improving your payment integrity and/or utilization review team’s productivity and timeliness during medical record reviews for medical necessity/level of care – while maintaining quality.
  • Nurses can share only findings from their denial appeal reviews – and further streamline doctors’ time with CAVO’s annotate, highlight, and notes functionalities.

DRG

  • Facilitates escalation of medical record reviews to clinicians.
  • Typically surfaces the DRG information needed to make a coding determination regarding a provider appeal within 1-2 searches.

Evaluation & Management (E/M)

  • Utilizing Advent’s NLP resources, CAVO works with clients to automatically capture the appropriate codes for large volumes of E/M cases.
  • Systematically assigns an E/M code with a confidence score based on documentation that meets history, exam, and medical decision making using the 1995 and 1997 guidelines.

Fraud, Waste & Abuse (FWA) Reviews

  • Searches across FWA cases or through specific provider cases – including images – to prioritize suspects.
  • Builds custom reports to surface medical record review trends by providers, DRG codes, etc.
  • Delivers a scalable solution for FWA audits, regardless of database size or total records.
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Does your health plan have an initiative to increase itemized bill reviews this year?
Do you outsource itemized bill audits – or parts, such as itemized bill transcription into an Excel spreadsheet?

Increase IB review efficiencies by 5X+ with CAVO

CAVO Service: Itemized Bill Reviews

This technology intakes itemized bills (IBs) and re-formats them into filterable data, enabling you to:

  • Sort and filter by revenue codes, dates, and item descriptions.
  • Easily make line-by-line accept/reject decisions with customizable reason codes for each.
  • Efficiently perform quality assurance of the IB within CAVO by comparing against the original hospital bill line.
  • Auto-sum totals in real-time – including line detail of adjusted amounts.
  • Create reports with auto-generated headers.
Read More: IB Reviews

Proven Platform

0+%
faster medical record reviews
0+
completed case reviews
0+M
lives covered by clients
0+
end-users in single organizations

Client Snapshot

Large National Payer, Post-Pay DRG Reviews

THEN

Payer received medical record documents via fax, mail, portal, email, etc. The nurse review team completed page-by-page reviews to validate the DRG. Overflow was distributed to vendors.

NOW

Nurse review team accesses aggregated medical record documents and searches for decision-making data. They complete findings “packets” within CAVO, also.

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CAVO Results Calculator

Estimate your medical review team’s increased productivity.

TRY CALCULATOR

Architecture purposefully built for medical record reviews

End-user experience

Loads 100K+ page records within seconds, while accommodating slower internet connection speeds that can limit remote staff

Enables drill-down QA of remote staff

Utilize CAVO productivity reports and search audit logs to perform QA reviews and customize training

30,000+ development hours  I  5+ years of enhancements 

Client Snapshot

Regional Health Plan, Pre-Pay DRG Reviews

THEN

Nurses performed DRG validation reviews from providers EMRs. After navigating one of multiple EMRs plus accessing a shared drive, Microsoft Word, and email, the final step was updating their workflow system.

NOW

Instead of reviewing directly within the EMR, nurse reviewers easily export a PDF of the medical record and load it into CAVO, transforming it into searchable, actionable data.

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BEST-IN-CLASS MEDICAL RECORD REVIEW TECHNOLOGY

ENTERPRISE PLATFORM

Highly scaled architecture promotes stability, strong SLAs, and adoption

FULL TEXT
OCR & SEARCH

CAVO’s proprietary full text search functionality makes indexing and/or categorizing medical records and itemized bills unnecessary

OPEN API

Our RESTful API endpoints allow your systems to interact in real-time with CAVO

DESIGNED FOR
END USERS

Very friendly user interface with optional functionality for a multitude of use cases

MORE ABOUT OUR TECHNOLOGY

What Our Clients Are Saying

“Not only can reviewers easily pull up a patient’s entire file on the computer screen, now with a few keystrokes they can search a 10,000-page medical record and see all references to specific data points within seconds…[our] ultimate goal in switching to CAVO’s technology is to migrate all of our records into CAVO.”

Manager, Payment Integrity

3 REASONS TO USE CAVO

STREAMLINE
MEDICAL CLAIMS
REVIEW PROCESS

CAVO transforms the medical claims review process by intaking medical record documents and images to create searchable data with our proprietary OCR.

EFFICIENTLY
ASSEMBLE
DOCUMENTS

Use CAVO to create “findings” summaries within the imaged medical record. The result is an efficient packet including only data relevant to that claim.

PLAN FOR
TOMORROW’S MEDICAL
CLAIMS REVIEWS

Leverage CAVO to automate audit segments today while facilitating future machine learning for claims reviews.

By the Numbers:
A CAVO Client Success Story

Payment Integrity Solution for Medical Record Reviews

While many technology companies specialize in healthcare, CAVO Payer is one of the few technologies specifically designed for health plan payment integrity and utilization review departments—delivering a comprehensive solution to inefficiencies throughout the medical claims review process. Our platform’s goal is to streamline the medical record review process, increasing appropriate reimbursement efficiencies.

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Interested in a CAVO demo?

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