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Introducing ClaimAnalysis™ Mitigate denials and recover lost reimbursement

ClaimAnalysis™ is an analytic tool that utilizes a combination of clinical logic and cluster analysis to compare similar groups of paid and denied claims. The objective of the comparison is to identify diagnoses common among the paid claims that are missing from the denied claims.

Identify Groups of Similar Claims

ClaimAnalysis’ unique combination of cluster analysis and LCD (Local Coverage Determination) information allows Denial Management staff to more quickly and easily identify possible coding-related denials and recover lost reimbursement. ClaimAnalysis allows users to identify groups of similar claims through several easy, intuitive methods:

  • Browse and sort a table that contains information about each unique group.
  • Search for a claim group by specifying a procedure code or principal diagnosis.
  • Specify an account. ClaimAnalysis automatically returns a list of the possible comparison groups to which the account may belong.

Evaluate and Identify

After the user selects a group of comparable claims, ClaimAnalysis will return useful information to help compare and contrast the paid and denied claims. The ability to identify diagnoses common among the paid claims but missing from the denied claims is often considered the chief benefit by healthcare professionals.

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