The Problem: Unclaimed Revenue
For accurate claims submissions, Verisk Health continues to monitor your plan’s claims data to identify any missing claims or diagnoses rejected by CMS due to eligibility errors. We can help you to identify whether a diagnosis code maps to a health condition code. In addition, accepted RAPS diagnoses are reviewed regularly to identify gaps between your claims information and what has been submitted to CMS for risk adjustment.
The Solution: Data Validation
Features
- Data acceptable for risk adjustment and is not in RAPS return data.
- Any claims we believe should not have been submitted with an explanation of why we do not believe it is an acceptable encounter.
- Claims rejected by CMS, which are eligible for resubmission.
- Any claims types that are potentially subjective in nature and require additional research and/or guidance from CMS.
Benefits
- Increased ROI
- Provide clients with a 100% compliant revenue enhancement program
- Accurately attribute ROI from the appropriate source
- Understand the source of the submitted diagnosis
Next Steps
Data Validation
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