Clinical Claims Management

Effective, clinically informed claims management service that identifies areas of concern in payment systems.

Clinical Claims Management enables the regular, systematic monitoring of acute claims accuracy from a transactional and clinical perspective. This informs strategy and purchase decisions as well as generating provider challenges. We verify the clinical codes using NHS Connecting for Health national standards.

Product features

Data cleansing to ensure adherence to NHS Data Dictionary
The automated transactional rules engine identifies ‘administrative’ queries in the data
The automated clinical rules engine identifies questionable claims
Our team of experienced clinicians review clinically coded claims

Benefits

Enhanced cost containment with 3-6% of monthly claim value identified as savings
Alignment of service provision and population need through acute services redesign
Typically double the savings are identified with clinical review
Improved clinical governance
Evidence based engagement between clinicians and commissioners