Payment Integrity Record Retrieval Solutions Comparison

Comparing apples to oranges

PLAN BENEFITS RECORD RETRIEVAL FUNCTIONS INSOURCE OUTSOURCE PORTAL REQUEST TECHNOLOGY AUTOMATED TECHNOLOGY Plan sends remote retrieval requests fulfilled by provider Plan performs on-site retrieval requests Plan sends remote retrieval requests fulfilled by provider Plan performs on-site retrieval requests Technology vendor sends on-demand requests via portal CAVO Connect uses FHIR calls to extract records Automate record […]

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 […]