Plan Client Success – CAVO DRG Validation Client

Nurse reviewing a medical chart in a hospital.

/ PRE-PAY / DRG / Northeastern Regional Health Plan Covering 1M+ Lives Advances DRG Nurse Review Team Productivity using CAVO DRG Validation THEN → Chasing the Records Before CAVO DRG Validation, the record intake team gathers the medical records, depending upon facility, by: Utilizing third-party electronic delivery services, Obtaining encrypted disks from the facility, Accessing […]

Plan Client Success – CAVO Post-Pay DRG Validation

Growing, rising chart and businessman in background.

/ POST-PAY / DRG / Large National Payer’s Post-Pay DRG Validation Team Achieves 300+% Productivity Increase with CAVO THEN This large national payer applies enterprise rules, edits, and analytics to all post-pay DRG claims to pinpoint “suspects” for potential overpayment, which are then reviewed by a team of RNs. Analytics were performed on claims that […]

Plan Client Success – CAVO Pre-pay DRG reviews at Regional Payer

Nurse sitting in front of computer at a desk.

/ PRE-PAY / DRG / Regional Health Plan’s Pre-Pay DRG Review Team Uses CAVO to Increase Productivity by 200% THEN RNs performed DRG validation reviews primarily from providers’ EMRs. Reviews were a page-to-page comparison (often averaging 500+ pages per case) within slow systems with cumbersome navigation. Once RNs located decision information, they created screenshots and […]