In addition to an automated claims review or a detailed physician review we also provide the following services:
- Standard validation of code fields (ensures that the code - procedure, diagnosis, modifier, place of service, etc. - is a valid code, and is valid for the submitted date of service)
- Correct coding initiative (CCI) validation
- Medically unlikely edit (MUE) validation
- Procedure and diagnosis usage validation (includes checking of procedure and diagnosis codes for age, gender, primary/secondary, and other appropriateness)
- Modifier and procedure validation
- Place of service and procedure validation
- Medical necessity validation (included by default for all Medicare regions; private payer and Medicaid databases available by request)
- Patient history validation (checks global periods, frequency edits, and appropriateness of new and established patient codes)
