CHALLENGES – Health Plans |
SOLUTIONS – CAVO IB Reviews |
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CHALLENGE |
DESCRIPTION |
FUNCTIONALITY |
RESULTS |
| Accessing accurate data | Those beginning to utilize other technologies to attempt IB data capture are experiencing limited success with accuracy. | Automatically extracts information from thousands of IBs. Enables efficient QA with confidence scores and click functionality that opens the corresponding IB page. | Delivers the most accurate IB information in the industry. |
| Automating workflow | Perform labor-intensive re-keying of an imaged IB into Excel or directly into systems/workflows. | Extracts the data from an imaged IB and maps into current systems/processes. | Makes extracted IB data available within the organization’s workflow. |
| Finding itemizations within the IB, as well as inconsistent application of reason codes | Auditors identify nonallowable charges within the IB via line-by-line reviews and manually assign reason codes. |
End-users sort and filter IB data by revenue codes, DOS, and more. Use bulk adjustments to bundle similar charges for increased efficiencies. | Decreases provider appeals and administrative tasks. |
| Collaborating across departments | Siloed reviews occur across various departments. | End-users easily include or exclude charges by flagging them. | Reduces duplicated works and adjudications across other departments, such as UR. |
| Manually generating provider reports | Lack of formatting and/or formal structure as health plans document reasons for rejection(s). | End-users can quickly share findings with providers — including specific line items and reason for rejection(s). | Minimized – EMR user access, vendor/visitor credentialing, etc. |
