Claims are arguably the single most important data gathering aspect of any healthcare operation. These key data points are critical to risk adjustment and program integrity.
Because Envolve recognizes the importance of timely, accurate claims adjudication, we offer a solution designed to provide accurate and complete original healthcare claims management support, including management of encounters submissions backed by supplemental diagnosis data.
Envolve, through its family of companies, provides both accurate and complete original encounters submissions, as well as supplemental diagnosis data in HIPAA compliant paper and EMR formats.
We can also support various proprietary submission formats as required.
Our claims processing system includes an audit trail to retain snapshots of all transactions for current and historic activity.
We compare financial data (from paid claims) with corresponding encounter submissions to ensure encounter data is a complete representation of the healthcare services provided.
Envolve Health always aims to provide accurate, and complete encounter data to our clients. When a recognized risk or delay is detected we immediately work to identify the root issue, conduct analysis, and provide resolution in accordance with applicable standards.
Our claims adjudication process is the same for both network and non-network providers as well as traditional and non-traditional providers.
We complete a six-step claims adjudication process test that a claim must pass in logical succession to reach a “finalized” (paid or denied) status.
With proven technical management capabilities, we are experts at gathering, analyzing, and reporting healthcare claims data.
Our claims adjudication team can quickly identify and take action against inappropriate utilization of services and quality of service concerns.
This proactive approach to uncovering fraud, waste, and abuse, resulted in over $1.2 billion in savings in 2016 through all of Envolve’s affiliated health plans . This figure includes coordination of benefits savings, cost avoidance savings by and recovery activities on unpaid claims.
Envolve Health is a claims management provider committed to working in your best interest to eliminate administrative burdens and simplify the claims adjudication process. Contact us today to get started.