Medical and Insurance reviews are conducted by a specialist team of qualified professionals with a different set of medical skills and backgrounds. This team includes medical doctors, pharmacists, nurses, physiotherapists, laboratory specialists, and several other paramedic staff, who have insurance expertise in reviewing medical necessity and insurance protocols.
Medical reviews are conducted to validate and assure medical record documentation is complete and billed services are justified and compliant as per the patient’s health insurance policy. The reviews also ensure that all insurance and pre-approval protocols are strictly followed for each claim thereby helping to:
–Decrease the chances of rejection and ensure early payment;
–Monitor physician error trends and patterns that adversely impact cash, while identifying and analysing rejection trends;
–Identify training needs for providers to address the known defaults and decrease rejection rates; and
–Regularly provide feedback to enhance the smooth process flow.