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/or audits with a focus on:
- Payment accuracy
- Regulatory evaluation
- Denial accuracy
- Provider payment accuracy
- Eligibility accuracy
- Contract pricing accuracy
- Coordination of benefits accuracy
- Documentation of payment decisions
- Fraud, waste and abuse
- Special investigative unit
- Pre- and post-edit configuration
- Development of action plans based upon audit results
- Claims policy and procedure review and/or development
- Claims training development and support
- Benefit and provider contract configuration review and remediation
