Health Plan Itemized Bill Review Challenges & Solutions

CHALLENGES – Health Plans

SOLUTIONS – CAVO IB Reviews

CHALLENGE

DESCRIPTION

FUNCTIONALITY

RESULTS

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.