With fee schedules being cut, insurance
companies scrutinizing claims and coverage determination on
the rise, getting paid from insurance companies is getting tougher
everyday. Claim Staker is a claim scrubber that looks at claims
that you are billing and ensures the claims are accurate before
they are filed. Claim Staker utilizes the most comprehensive
medical necessity database, providing the same technology payers
use ensuring your claims are accurate before they are filed.
Our claim Scrubbing has three types of edits.
1.
Ansi Format Edits
Prevents batch rejections
Verifies maximum / minimum field lengths
Checks sequencing of loops and segments
Confirms accuracy of data content
2.
Coding Edits
CPT / ICD9 validity
Medical Necessity (LMRP/LCD/NCD and
proprietary)
RVU Sequencing in the case of multiple
payment rules
CCI Edits to prevent unbundling
Modifier Edits of all types
ICD-9 Highest Level of Specificity
ICD-9 Secondary Code Suitability
CPT / Patient Gender & Age Accuracy
Evaluation of E/M Level of Service with
diagnosis acuity
