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Claims Edits

Advanced, Seamless Software

<p>Prime Health Services offers advanced, seamless claims review software that delivers maximum savings on medical claims and full alignment with industry-recognized guidelines and ever-changing compliance requirements. Through our supplemental, non logo national PPO network, we have the ability to do front-end claims edits.</p> <p>Our proprietary claims review software (Renovo) offers Prime Health clients real-time PPO discounts, along with the most current coding reviews, duplicate detection, industry specific adjustments, as well as client specific rules. A rule-based software application, it ensures accurate payment is made on all claims of all types and sizes and successfully saves the maximum dollar amount without jeopardizing the patient’s care.</p>

What if you could elevate your claims management process? 

Speed, accuracy, and ease of processing are just a few of the reasons filing electronic claims is so popular. To save your staff time and your organization money, claims editing software is beneficial to implement.

  • audit medical claims to uncover coding accuracy errors and inappropriate charges
  • visualize productivity and claim submission
  • straightforward Explanation of Benefits (EOB)
  • adhere to industry-standard coding practices based on Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) guidelines
  • cloud-based and top data integrity (SOC-Type 2 certified)
  • increase staff efficiency
  • cleaner processing
  • leverage claims intelligence to better focus attention and efforts

What if you could make your claims even more accurate?

<p>Our proprietary editing software identifies coding errors related to unbundling, modifier appropriateness, mutually exclusive and incidental procedures, inappropriate billing, and questionable coding relationships. By utilizing a knowledge base containing more than nine million government and industry rules, regulations, and policies governing health care claims, the software gets a claim as accurate as possible for you – with no other human interaction necessary. It also edits across providers in the same group or specialty per Medicare guidelines. The editing rules are built upon current medical practice standards and nationally recognized and accepted sources, including guidelines by the American Medical Association, CMS guidelines, and the National Correct Coding Initiative.</p>