Ensuring your claims are accurate is one of the most essential areas within your organization. It’s critical to ensure that:
- System configuration is correct
- Claims are coded and billed in accordance with standards
- Providers and fee schedules are set up correctly
- Controls are in place to ensure all items and services billed to each of your programs are medically necessary and documented
ATTAC’s claims’ consultants have worked in or with large claims operations. Each consultant has a business-efficiency and technology-enablement focus that we pair with best practice recommendations to support your organization in countless ways, including:
- Claims reviews and remediation plans with a focus on:
- Regulatory and contract compliance
- Eligibility verification
- Adjudication details – benefits, prior authorizations and CCI/NCD/LCD
- Payment and denial accuracy
- Coordination of benefits, third-party liability, FWA/SIU processing
- Documentation of payment decisions, including member and provider communications
- Encounter processing and submissions
- Claims policy and procedure review and/or development
- Claims training development and support
- Benefit and provider reimbursement configuration and remediation
- Market Conduct Audits
