For payers, the ability to catch claims errors before processing greatly streamlines workflow and reduces costs. Capario solutions routinely eliminate many basic mistakes by verifying patients' insurance eligibility, applying payer-specific rules and spotting HIPAA violations. And we go a step further. We also offer specialized services that screen and scrub your electronic claims before you receive them, saving you valuable time.
As a result, you can more easily identify fraudulent claims before processing, receive claims with the correct clinical codes and process claims automatically in electronic format.
Fraud and abuse detection discovers unlicensed or unsanctioned providers, high-risk addresses, past investigations or suspected billing patterns. We apply this screening technology as an optional filter for all of a payer's inbound claims.
Clinical code editing in a pre-receipt and pre-adjudication environment is an optional filter that checks for issues such as medical necessity, service over-utilization, procedure-to-diagnosis issues and code validity, avoiding the expensive process to reverse payments.
Scanning and conversion functionality enables payers to reduce in-office paper by converting it into an electronic format, reducing operational expenses and maximizing auto-adjudication rates.
With these services you have assurance that you are processing only "clean" claims and reimbursing the appropriate amount for the healthcare services provided.
With Capario's best-of-breed services, you can more easily identify fraudulent claims before processing, receive claims with the correct clinical codes and process claims automatically in electronic format.