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  • Phone: 1-888-406-4711
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Services

ServicesDRG Claims Management provides an innovative approach to DRG claims validation and recovery of confirmed over-payments on behalf of the segment of payors that pay claims based on DRG methodology: Medicare Advantage, Managed Medicaid, commercial plans, IPAs, TPAs, ASO/MSOs, Managed Long Term Care Programs (MLTC), and PACE programs, Additional wrap around services are also offered, including:

  • Identification of cases requiring medical necessity and re-admission reviews
  • Hospice services recoupment for Medicare Advantage plans
  • Cost outlier reviews: DRG coding analysis and medical necessity validation of length of stay / level of care of each billed day with the goal of reducing or eliminating the outlier surcharge
  • Third party “tie breaker” reviews for unresolved DRG claim disputes
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