Our Health Plan Payment Integrity Solutions
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.
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.
Automated Chart Retrieval
Simplify the clinical documentation and record retrieval process for claims reviews with CAVO® Connect and Apello Apps.
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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