Medical Claims Review
Medical Claims Review

Medical claims review is the process used to assure that provider billings are accurate, reasonable and appropriate for services that have actually been provided.

Benefits:

  • Significant cost savings to the Plan

  • Early identification of potential Case Management patients

  • Increased ability to trend possible questionable billing practices

  • Increased accuracy in claims processing

  • Timely notification to Reinsurance of High dollar cases

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