For both the healthcare provider and payor, properly undertaking claims processing, audits, and risk adjustments is critical. Under a myriad of existing and new State and Federal legislation, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, Medicare Advantage programs, and multiple Medicaid program initiatives, the importance of proper documentation, tracking, and reporting of claims and patient health expenditure risk have been brought to the forefront. So too, however, has the need for proper surveillance for fraud, abuse, waste, and errors with claims submissions and processes.

MedAssurant's medical informatics team understands the multifaceted issues surrounding claims processing and risk adjustment analysis, as well as methods through which effective surveillance, analysis, and corrective action solutions are implemented. Applying comprehensive clinical, technological, financial, and regulatory knowledge, MedAssurant delivers superior ability to implement highly cost effective solutions to minimize waste, fraud, abuse, overpayment, and errors regarding reimbursement and capitation payment rates.

Empowered by the ability to undertake market-leading claims analysis and risk adjustment in concert with nationwide medical record abstraction and review infrastructure, MedAssurant delivers an unmatched end-to-end solution. With hundreds of centralized data analysts, clinicians, review project managers, review schedule coordinators, data cleaning, and quality personnel – combined with hundreds more nationwide, in-field clinical review nurses, data collectors, and certified coders -- MedAssurant provides value-added insight, quality, reliability, and end-to-end peace of mind to its clients.