How Medical Claims Review Support Services Can Simplify the Review Process

Medical claims have to be reviewed for accuracy and authenticity before payment. Insurance companies have physicians and attorneys review the claims they receive to establish their validity. Such evaluation involves a close scrutiny of medical records and comparison with medical bills - an intricate and time consuming task. However, the medical claims review support services offered by established outsourcing firms in the United States can greatly simplify the review process and ensure that insurers pay only for the treatment and services delivered.

Medical Claims Review – Support for Review of Relevant Medical Records

Efficient medical review services are crucial in the claim review process. Support service providers conduct a detailed review of the medical records relevant to the case to determine claim legitimacy. Errors in claims can occur due to the use of wrong codes and errors in the entry of information in the medical record. Outsourcing firms handling medical review tasks for insurance companies help to conduct a detailed review of the claims with the following services:

• Separating the records and breaking tabs into sub-sections
• Referencing the document tab and assigning identification numbers
• Referencing the claimant
• Referencing important dates
• Organizing and indexing medical records
• Classifying and tabulating relevant medical record information
• Reviewing the information for errors
• Developing summaries, chronologies and timelines

Following the evaluation of the medical records, they are compared with the itemized bill to establish accuracy.

Comprehensive Support to Review Complex Medical Claims

Complex medical claims relate to cases that that involve serious injury and have unique diagnoses and obstacles to recovery, as for instance, workers’ compensation and liability claims. Numerous parties such as employers, healthcare providers, employees and others may be involved. Competent outsourcing firms can offer the medico-legal industry support to review even such complex claims. Their valuable assistance for utilization reviews helps to review request for medical treatment in such cases.

Medical Claim Review – Save Time, Minimize Costs

Attorneys and physicians conducting medical claims review for insurance companies can save time and minimize costs by outsourcing the task to established medical record review companies. These service providers are well-equipped to handle the task and can offer affordable solutions in customized turnaround time. Their staff is experienced and trained in providing support service for medical claim review. It is important to outsource to a HIPAA-compliant company to rule out breach of confidence in dealing with patient information. An efficient service provider can greatly simplify the claims review process and prevent errors in payment.