Advanced Error Detection
PlutoX Advanced Error Detection plays an instrumental role by utilizing advanced clinical editing technology to ensure that both institutional and professional claims are properly coded and compliant with applicable payer requirements.
PlutoX Advanced Error Detection examines the whole claim and identifies procedure-to-diagnosis mismatches, unbundling occurrences, use of nonspecific diagnosis codes, global service violations, potential unbilled revenue, and many other problem areas that can adversely affect not just claims processing, but a provider’s overall practice. PlutoX Claims Editing is deployed using cloud or client server based technologies. Customized rules can be created to meet customers specialized needs.
Our solution contains millions of edit combinations based on commercial, Medicare, OIG and Medicaid policies. The unique editing, reporting, and work flow capabilities in our Claims Editing deliver significant cost advantages.
‘Clinical Editing’ as opposed to ‘Technical Editing’: Edits are specific to the clinical coding aspect of the claim including unbundling edits, ICD/CPT® mismatches, global period violations, complete local medical review policies, correct coding initiatives, provider oversights and regulatory reporting whereas other solutions only edit technical aspects.
The unique editing, reporting and work flow management capabilities in our Claims Editing products deliver significant quantifiable cost and compliance advantages to Healthcare organizations.
We offer a FREE analysis of your paid claims to determine any additional savings that could be obtained above and beyond what you already have in place. Contact Us for more information.