Lovelace Health Plan (Albuquerque, N.Mex.) is integrating HealthCare Insight's (HCI) e code editing and clinical review service into its claims review processes.
The service, called First Insight, will ensure accurate claims reimbursement, provide support in instances of appeals, and identify aberrant provider activity that may indicate fraud, says HCI.
According to HCI, the service combines its proprietary Code Corrector (rules-based) and Fraud Finder Pro (profiling) software systems with claims review by RN Coding Specialists and suspect provider validation by a Clinical Investigative Unit (CIU). Payers that integrate First Insight e into claims adjudication operations realize savings from $1 to $5 per member per month (PMPM) over and above existing claims payment processes, contends the Sandy, Utah-based company.
