MedAssurant’s Claims Integrity™ solution brings to each client’s fraud, waste, and abuse initiative a powerful edge with regard to the critical and logistically-intensive medical case review, analysis, and validation process. Truly standing out within the industry, MedAssurant provides a fully integrated medical record review and analysis process which actively provides services in all 50 states. Where other solutions utilize outsourced medical record review and temp agency staff, MedAssurant follows a strict policy of utilizing only employees of MedAssurant – each of whom has undergone comprehensive background checking, training, inter-rater reliability, and quality oversight testing.
Further to using the right people is using the right technology. MedAssurant’s medical record review, analysis, and validation process is a highly targeted process by virtue of three integrated platform technologies known as SRSA™ (Site Review Support Application), iDCT™ (Integrated Data Collection Tool), and ChaseWise™ technologies.
MedAssurant’s SRSA™ system orchestrates the abstraction of millions of medical records from EMR and paper-based records within over 150,000 medical facilities nationwide: managing communications, direct EMR connectivity, coordinating onsite and reviewer scheduling, constructing medical record “pull lists”, and minimizing clinical facility interruptions.
The iDCT™ receives and maintains all relevant medical data critical to validating or resolving fraud, waste, and abuse signals, quality outcomes, risk adjustment, and a host of other initiatives. Being aware of each enrollee’s pertinent medical data as well as the respective fraud, waste, and abuse technical specifications, MedAssurant’s iDCT™ is able to ask the right questions and validate the provided answers. Additionally, the iDCT™ provides for the collection of digitized content of the relevant medical record components to substantiate findings.
Additionally, Claims Integrity™ includes MedAssurant’s proprietary, clinically based, and field-proven chart chase logic known as ChaseWise™. Built upon extensive physician clinical input, and combined with the analysis of more than 3,000,000 medical record chases and reviews, MedAssurant’s ChaseWise™ system enables informed control of each client’s EMR-based and paper-based medical record review chart chase determination processes. ChaseWise™ is designed to implement an optimized approach to selecting and prioritizing qualified medical facilities and providers holding medical records in need of review, allowing the medical record review process to occur in a timely and efficient manner to maximize data clarification and reimbursement results and minimize the cost and time incurred in the pursuit of unnecessary medical records. While designed to take into consideration the many parameters necessary to properly determine optimal variant chart chase approaches, ChaseWise™ can also be customized by each client in order to benefit from their local knowledge of market population differentiators inherent in Medicare, HMO, PPO, POS, PFFS, SNPs, rural, urban, and other market specific differences – all aimed at optimizing data accuracy and reimbursement - as well as cost efficiency.