CHALLENGES – Health Plans
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SOLUTIONS – CAVO IB Reviews
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CHALLENGE
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DESCRIPTION
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FUNCTIONALITY
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RESULTS
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Accessing accurate data |
Those beginning to utilize other technologies to attempt IB data capture are experiencing limited success with accuracy. |
Automatically extracts information from thousands of IBs. Enables efficient QA with confidence scores and click functionality that opens the corresponding IB page. |
Delivers the most accurate IB information in the industry. |
Automating workflow |
Perform labor-intensive re-keying of an imaged IB into Excel or directly into systems/workflows. |
Extracts the data from an imaged IB and maps into current systems/processes. |
Makes extracted IB data available within the organization’s workflow. |
Finding itemizations within the IB, as well as inconsistent application of reason codes |
Auditors identify nonallowable charges within the IB via line-by-line reviews and manually
assign reason codes. |
End-users sort and filter IB data by revenue codes, DOS, and more. Use bulk adjustments to bundle similar charges for increased efficiencies. |
Decreases provider appeals and administrative tasks. |
Collaborating across departments |
Siloed reviews occur across various departments. |
End-users easily include or exclude charges by flagging them. |
Reduces duplicated works and adjudications across other departments, such as UR. |
Manually generating provider reports |
Lack of formatting and/or formal structure as health plans document reasons for rejection(s). |
End-users can quickly share findings with providers — including specific line items and reason for rejection(s). |
Minimized – EMR user access, vendor/visitor credentialing, etc. |