Plan Client Success – CAVO DRG Validation Client

Laptop computer with graphs and charts on screen

/ PRE-PAY / DRG / Northeastern Regional Health Plan Covering 1M+ Lives Advances DRG Nurse Review Team Productivity   THEN   → Chasing the Records 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 the facility’s electronic portal, or Visiting […]

Plan Client Success – CAVO Post-Pay DRG Validation

Laptop computer with graphs and charts on screen

/ 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 […]

Plan Client Success – CAVO Prepay DRG Reviews at Regional Payer

Nurse working with chart in hand

/ 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 […]