Payment Integrity Record Retrieval Solutions Comparison

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PLAN BENEFITS RECORD RETRIEVAL SOLUTIONS 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 […]

Plan Client Success – CAVO Pre-pay DRG reviews at Regional Payer

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/ 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 created screenshots and […]