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Accuracy changes everything.
Identify overpayments and underpayments

IDENTIFY

Identify overpayments and underpayments
RESOLVE
Identify overpayments and underpayments
PREVENT
Payment integrity

Overpayments

Identify, resolve, and prevent unnecessary spend.

✓ Data Mining & Recovery
✓ COB Identification & Recovery
✓ ESRD Audit
✓ Clinical & Coding Validation
✓ AI Labs / Payer Intelligence

Credit Balance

Credit Balance

The intersection of payment accuracy.

✓ Credit Balance Audit + TRENDSubmit
✓ Credit Balance Management & Prevention

Denial Management

Underpayments

Identify, resolve, and prevent revenue leakage.

✓ Denial Management
✓ Zero-Balance Accounts Analysis
✓ AR Rundowns

Plan Client Success – CAVO Pre-pay DRG reviews at Regional Payer

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...

Case Study: Accelerating Medical Necessity Reviews With CAVO®

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...
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