Facility Claim Review

Innovative Technology Advancements

One of CorVel’s core competencies is reducing the total cost of facility claims through a combination of rules based technology, clinical expertise and expert knowledge of nationally accepted reimbursement guidelines and methodologies. Our ability to customize processes allows for the inclusion of the commercial, self-insured, Medicare or Medicaid plan specific guidelines. We offer a winning formula by combining these elements into a single, powerful saving solution.

Simplifying even the most complex claims.
Our proprietary Universal Chargemaster is an industry unique compilation of individual hospital line item charge descriptions from over 97% of the nation’s hospitals. It is a virtual thesaurus of hospital billing terms, codes and abbreviations and is used to match the hospital chargemaster line item descriptions to our Universal Chargemaster. The CorVel database provides transparent defensibility of itemization adjustments and appropriate geographic repricing.

Experience delivers unsurpassed results.
CorVel’s staff of experienced nurse reviewers and Certified Professional Coders (CPC) have backgrounds in all areas of medicine, medical billing and coding to ensure an accurate, consistent and thorough review. Our nurses perform a thorough review for utilization, appropriateness of charges, duplicate items, unrelated supplies, time increment charges and quantity discrepancies. 

Expertise with outlier claims.
Unlike predetermined payment amounts for most facility claims, outlier claims involve extraordinarily high incremental costs, as they are based on the charge amount above the Diagnosis Related Group (DRG), hospital or fixed-loss threshold. Our itemization review ensures only appropriately billed charges are included in outlier payments.

Ensure accurate implant payments. 
We also have a proprietary database comprised of actual manufacturers implant invoices from across the country. This database provides a multilayered approach to determine cost in order for CorVel to apply a reasonable reimbursement.