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+%
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
Streamline medical record reviews and solve common challenges:
Case inorganization
Lack of resources
Evolving review thresholds
Administrative costs
Multi-platforms and siloed reporting
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 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
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.
Proven Platform
CAVO Itemized Bill Reviews
Increase hospital bill review efficiencies 5X+
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.
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.
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.
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
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
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
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
A CAVO Client Success Story
