by | Feb 19, 2021 | Article, CAVO, CAVO for Payment Integrity, Health Plans & Partners
Combating Common Health Plan Challenges If you’re an executive at a health plan, you likely spend a fair amount of time and energy thinking about minimizing provider abrasion, but what about the health plan challenges you face on the payer side of the equation? Health...
by | Feb 16, 2021 | Article, Client Success, Health Plans & Partners, Payer Client Success
Northeastern Regional Health Plan Covering 1M+ Lives Advances DRG Nurse Review Team Productivity using CAVO DRG Validation THEN → Chasing the Records Before CAVO DRG Validation, the record intake team gathers the medical records, depending upon facility, by: Utilizing...
by | Jan 29, 2021 | Article, Client Success, Health Plans & Partners, Payer Client Success
Regional Health Plan Decreases Pre-Pay Hospital Bill Review Time by 500+% Per Case Using IB Reviews THEN This regional health plan has an internal team of RNs performing hospital bill pre-pay IB reviews. Nurse reviewers previously either: requested the itemized bill...
by | Nov 25, 2020 | Article, Client Success, Health Plans & Partners, Payer Client Success
Cost Containment Readmission Reviews Unit Experiences 6:1 ROI During CAVO® Kick-Off Training THEN Client reviewers had to first locate the records associated with the case. Next, reviewers located appropriate documentation within the case (e.g., ED notes, Admission...
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...
