Plan Client Success – CAVO Itemized Bill Reviews Managed Care Enterprise

Multi-line Managed Care Enterprise Reviews FI

/ ITEMIZED BILL REVIEWS / National Managed Care Payer Saves $2M+ in 10 Minutes   THE CHALLENGE   A National Multi-line Managed Care Payer that serves as a central intermediary for both government-sponsored and privately insured health care programs saved $2M+ in 10 Minutes by leveraging our CAVO® end-to-end platform. The organization was tasked with […]

Plan Client Success – CAVO DRG Validation Client

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/ 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 Prepay Itemized Bill Reviews

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/ PREPAY REVIEWS / ITEMIZED BILL REVIEWS /   Regional Health Plan Decreases Pre-Pay Hospital Bill Review Time by 500+% Per Case    THEN   This regional health plan has an internal team of RNs performing hospital bill pre-pay reviews. Nurse reviewers previously either:  requested the itemized bill (IB) directly from the provider based on […]

Plan Client Success – CAVO Cost Containment Readmission Reviews

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/ POST-PAY /   Cost Containment Readmission Reviews Unit Experiences 6:1 ROI During CAVO® Kick-Off Training   THEN   Client reviewers had to first locate the records associated with the case. Next, reviewers located appropriate documentation within the case (e.g., ED notes, Admission notes, H&P) to find presenting symptoms and reasons for admission. Nurses then […]

Plan Client Success – CAVO Post-Pay DRG Validation

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/ 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 […]