Allies in fighting for what’s yours

DRG Claims Management boasts unrivaled expertise in verifying that all diagnosis and procedure codes were billed appropriately in accordance with Official Coding Guidelines and consistent with documentation in medical records, resulting in accurate DRG assignment and reimbursement.

Your plan. Your Way

We offer customized experiences that meet every plan’s unique objectives at every step of the process. We never forget that we represent your interests, and have set infrastructure in place to expertly accommodate the solutions you seek.

  • Post-pay, Prepay, Hybrid Models and 2nd Pass
  • Process Customization
  • Worry-Free Appeals Solutions
  • Consultation and Third Party Appeals Reviews
  • Proactive Prevention of Incorrect Billing Practices

Prepayment solutions

In our efforts to avoid auditing and recovery obstacles, we have developed a highly-acclaimed pre-payment auditing process that has proven to be the most effective approach for all claims.
We work collaboratively to secure provider agreements, minimizing resistance, reducing turnaround time and ensuring ability to audit out-of-network claims.

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Don’t pay out of pocket before we’ve audited your claim

Audit selection algorithms

We focus our attention on where recovery is most likely. Our proprietary Aud-O-Scope and Aud-Vance audit selection technologies sift claims data with the click of a button, identifying an array of subtle coding red flags or inconsistencies.

Our coding experts further analyze the data, pinpointing the most appropriate audit candidates on the very same day.

Our comprehensive selection process relies on

  • Logic integration
  • Coding discrepancies
  • Clinical inconsistencies
  • Targeted indicators
  • Targeted indicators
  • Human touch
Audit better with DRG Claims Management