by | Nov 24, 2020 | Article, Client Success, Health Plans & Partners, Payer Client Success
Large National Payer’s Post-Pay DRG Validation Team Achieves 300+% Productivity Increase with CAVO THEN This large national payer applies enterprise rules, edits, and analytics to all post-pay DRG claims to pinpoint “suspects” for potential...
by | Nov 24, 2020 | Article, Client Success, Health Plans & Partners, Payer Client Success
Regional Health Plan’s Pre-Pay DRG Review Team Uses CAVO to Increase Productivity by 200% THEN RNs performed DRG validation reviews primarily from providers’ EMRs. Reviews were a page-to-page comparison (often averaging 500+ pages per case) within slow systems...
by | Nov 20, 2020 | Article, Case Study, Client Success, Health Plans & Partners, Payer Client Success
The Client A health plan is reviewing a medical necessity claim for a 50-year-old male with a neurostimulator placed for pain control related to chronic back pain and right lower extremity numbness. He is a former police officer injured while on duty with nine...
by | Nov 17, 2020 | Article, Case Study, Client Success, Health Plans & Partners
The Client A health plan is reviewing a claim for a 35-year-old female with a prosthetic heart valve who presented to the Emergency Department complaining of rectal bleeding and a six-day heavy menstrual period. The patient was especially concerned because she takes...
by | Nov 16, 2020 | Appeal Management, Article, Client Success, Health Systems & Hospitals, Provider Client Success
The Challenges An extensive Northeast health system, consisting of 30+ hospitals and more than 7,000 beds, found it challenging to manage their outpatient appeal managements. While the business operations were largely centralized, the limited clinical resources tasked...
