CLAIMS REVIEW services

Certain elements of payment integrity can be validated only with the review of records, contract matching or other unique processes. iHT has an array of services to enhance cost control, both medical and administrative, that assures the highest level of payment integrity.

DRG Validation
iHT’s Claims Review Services ensures coding and payment accuracy of inpatient hospital DRG claims. Using proprietary algorithms and the clinical expertise of Medical Directors and coding experts, iHT provides a superior selection and audit process to identify miscoded claims.

In addition to inpatient claims analysis, iHT’s team of professional analysts leverages our clinical expertise and ongoing reporting and metrics capabilities in order to provide clients with business decision support services.

iHT identifies inpatient DRG claims with potential errors, assures payment claim accuracy and consistently generates repeatable, defensible results for our clients (typically 1-2% of DRG spend) enabling payers to better manage escalating medical costs.

Evaluation & Management (E&M)
iHT works with clients to provide a full-service solution that combines analytics, payment policy, and clinical review to ensure appropriate coding and payment for E&M Services. iHT’s solution identifies suspected incorrectly coded claims prepayment and offers two implementation options to ensure that level of service billed is clinically appropriate for the service rendered.

Network Optimization and Out of Network
At the core of iHT’s network optimization service is a robust analytics engine with more than 12 years of claims experience from more than 80 different PPO's nationwide. iHT’s network management team works proactively to develop new PPO relationships that can improve utilization and savings for each client based on patient history, geographic location, and current market conditions. Using the insights of PPO matching, and contract analysis, iHT delivers substantial cost savings.

iHT’s network optimization process can identify those individuals needing a secondary analysis performed when, for one reason or another, the primary network may not be available to the member/insured (e.g. travel outside of the service area, etc.) and find an appropriate network solution for the member/insured or negotiate any remaining out of network claims on behalf of the healthcare plan. Together these solutions aim to improve and preserve the patient, provider, and health plan relationships both operationally and financially.