Investigate, Recover and Optimize
OUR VISION
The typical commercial health plan acknowledges that 2%-3% of all insurance payments are made in error. Jumbo payers staff large internal audit departments comprised of hundreds of employees to quickly detect overpayments. Internal audit teams often find half or more of the overpayments, consisting of “low hanging fruit” such as duplicate payments or COB errors. Upon review by internal teams, claims files are released to external vendors like Truclaim. Each external vendor subsequently finds millions in overpayments even after the internal team. Truclaim’s data mining expertise will assist any size health plan and any line of business in recovering overpaid funds quickly, efficiently and cooperatively. Truclaim Analytics ensures quality control measures are made to achieve 85% - 90% hit rate by claims submitted as overpayments. Truclaim Analytics considers results to be at the forefront of our service. This year, we will execute thousands of overpayment recoveries for our clients. We consider the day to day operations as an extension of our effort to serve our customers.
OUR VISION
TruClaim Analytics delivers unique claims payment integrity solutions specializing in data analytics, recovery of overpaid healthcare claims and pre-payment audit reviews. Our professional and knowledgeable staff has over 20 years of experience in the medical and health insurance industry and is motivated to help clients reduce healthcare costs. We provide an intricate analytics platform designed to optimize your data and leverage proprietary algorithms to recover overpayments. We approach payment recovery as a strategic alliance forming a partnership and working cooperatively to optimize results. We do not charge our clients an upfront fee and share the reimbursement of each dollar recovered.
COMPLIANCE REVIEWS
Itemized Facility Bill Review
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Medical Outpatient Pharmacy– Detection of overpayments for high dollar medications dispensed by physicians and or facilities involving incorrect unit dosages and or pricing errors.
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Facility Itemized Bill Audits – Identification of overpayments via review of medical records and the itemized bill.
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Out-of-Network – All out-of-network claims repriced through proprietary discount networks to assure the maximum allowable discount.
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DRG Validation - Focusing on the documentation in support of the coding as billed. Identifications include down coding, contract and policy compliance for MSDRG, APDRG and APC claims.
Annual Compliance Review
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Medical Outpatient Pharmacy– Detection of overpayments for high dollar medications dispensed by physicians and or facilities involving incorrect unit dosages and or pricing errors.
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Facility Itemized Bill Audits – Identification of overpayments via review of medical records and the itemized bill.
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DRG Validation - Focusing on the documentation in support of the coding as billed. Identifications include down coding, contract and policy compliance for MSDRG, APDRG and APC claims.
DATA ANALYTICS
Review and validation of overpayments for all types of facility and physician claims.
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Contract Compliance: Review contract terms for errors in missed or inappropriate discounts, capitated services paid as service fees, retroactive rate reductions and carve outs caused by errors in contract load or system limitations.
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Multiple Payments: Identification of duplicate medical payments, multiple providers, interim billing and split bills. Over one hundred algorithms are run against the data and thirty algorithms are run just to detect hard to find duplicates.
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Coordination of Benefits (COB): Incomplete or inaccurate primary and secondary group health insurance information on record for the plan participant at the time of claim payment.
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Provider Billing Compliance: Review of billing related to payment guidelines and policies’ including CCI edits, CPT coding, modifiers, typically for anesthesia, observation and readmission.
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Medical Chart Review: Certain overpayments require a more in depth review of clinical documentation to identify overpayments such as DRG.
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Retro-Termination: Review of claims to determine if terminated plan members received benefits in error.
DATE SCIENCE
TruClaim specializes in 2 distinct, but equally important methods of payment integrity; Data Science and Data Mining. TruClaim delivers customized, flexible and unrivaled performance to our clients. We are pleased to share our capabilities with you and to introduce Data Science as our newest and most innovative overpayment identification tool.
Through Data Science, TruClaim is able review your claims data from a uniquely different perspective, uncovering statistical significant outliers and patterns that are routinely missed through traditional algorithms. TruClaim’s auditors, technology specialists and scientists will investigate these patterns to uncover overpayments, fraud and overspending that would otherwise go undetected.
This product is unique to TruClaim. When TruClaim applies Data Science to a set of data, we truly are able to take a “forest from the trees” approach and apply an aerial view to the identification of recoveries.
SECURITY
Client security is our number one priority.
TruClaim Analytics ensures the safeguard of all client’s data by using:
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Secure FTP to transfer and download any client data
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Secure VPN to access client data internally
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Annual HIPAA and CMS trainings
CONTACT
800 Corprate Dr, Ste. 408 Fort Lauderdale, FL 33334
Email: info@TruClaimAnalytics.com
Tel: 1-888-843-5107
For any general inquiries, please fill in the following contact form:
About us
TruClaim Analytics offers unique claims payment integrity solutions, Specializing in data analytics, recovery of overpaid healthcare claims and pre-payment audit reviews. TruClaim’s staff has over 20 years’ experience in the medical and Health Insurance industry. TruClaim’s professional and knowledgeable staff is motivated to help its clients reduce healthcare costs. We provide an analytics platform designed to optimize your data and leverage proprietary algorithms to recover overpayments. TruClaim understands your business environment and measures return on investment. We approach payment recovery as a partnership and not as a vendor. TruClaim charges no upfront fee and shares a percentage of each recovery.