Claims Review and Contestation

Improve Provider Data Accuracy.
Mitigate Compliance Risk. Reduce Costs.

Our expert team has a capability of performing the below services for Medicare Advantage as well as Medicare Advantage Prescription Drug plans

Claim review is the process of analyzing the claims to identify overpayments and incorrect payments before check run. This process prevents wrong payments being made to the providers.

Claim Contestation is the process of analyzing and contesting overpayments and incorrect payments on paid claims. This process helps in recovering wrong payments made to the providers and helps in correcting the payer system.

  • Claim Adjustment is the process of verifying contestation approved claims to ensure adjustment of claims.
  • Recovery analysis is the process of analyzing the recovered claim details with adjustment claims to ensure  recovery of all adjustment claims.

Benefits

  • Quick turnaround time. Improve the time taken to adjudicate the claim
  • Improve Accuracy. Reduce errors through robust quality assurance processes and seasoned claims adjudicators
  • Strong Governance processes. Our robust governance processes ensure that you are always in control with detailed reports on claims inventory, and service level commitments.
  • Reduces costs associated with claims processing by as much as 30-40% through our deep global delivery model
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