Health Plans & Partners

Streamlining the claims review process.

Our Health Plan Payment Integrity Solutions

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Medical Record Review

CAVO® is an enterprise technology platform that streamlines the medical record review process by providing solutions to your payment integrity challenges in one place.

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DRG / DRG Predict

Our payment integrity platform, CAVO®, exponentially increases DRG audit efficiencies by minimizing your team’s administrative burden and maximizing their coding skill sets.

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Automated Chart Retrieval

Simplify the clinical documentation and record retrieval process for claims reviews with CAVO® Connect and Apello Apps.

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IB Reviews / IB Predict

CAVO® Itemized Bill Reviews intakes itemized bills and auto-extracts data to increase review productivity by at least 5x.

Common Health Plan Payment Integrity Challenges in the Claims Review Process

Systems

Utilization of multiple systems with varied interfaces typically impede productivity during health plan claim reviews.

Documentation

Retrieving clinical documentation for medical record reviews and itemized bill reviews is time-intensive and often produces PDFs requiring manual review.

People

Nursing shortages and widely varying average medical record review and itemized bill review times create staffing challenges.

Time

Timely filing requirements and consistently decreasing health plan payment integrity review thresholds require more productivity.

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