CHALLENGES – Health Plans
SOLUTIONS – CAVO IB Reviews
|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.
|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.