Ensure Appropriate Reimbursement for Every Claim
Payment integrity programs can be complex and require tailored subject matter expertise and credentials such as in-depth coding and clinical expertise to evaluate medical documentation during clinical chart reviews. To scale this labor-intensive process and move toward pre-pay arrangements, health plans need technology to help simplify data extraction, streamline workflows, and apply configurable rules and routing tailored to their internal and provider needs.
Apixio’s tech-enabled Clinical Chart Review solutions increase reviewer efficiency, accuracy, and transparency with automated, transparent, and configurable pre-payment workflows for clinical chart and DRG validation and other payment integrity programs.
Apixio’s tech-enabled Clinical Chart Review solutions increase reviewer efficiency, accuracy, and transparency with automated, transparent, and configurable pre-payment workflows for clinical chart and DRG validation and other payment integrity programs.
Faster, Simplified Chart Review Workflows
Repeatable, Accurate Review Results
Lower Provider Appeal Rates For Denied Claims
Benefits
Faster Claims and Chart Reviews
Our natural language processing (NLP) engine extracts, normalizes, and organizes clinical data so reviewers can complete audits more quickly.
Transparent, Scalable Workflow
Monitor reviewer productivity, claims status, and more with interactive dashboards that help you pivot your team’s focus based on program needs.
Configurable Rules and Routing
Control every rule, edit, and routing step with our highly configurable platform that supports your plan and provider partners’ unique processes.
Consistent, Accurate Results
Deliver accurate, consistent results that build confidence with providers and lower appeal rates.
The Impact
98%
Accuracy
98% review accuracy
50%+
Rate
50%+ Change Rate
<20
Minutes
<20 minutes per review
Features
Advanced analytics engine identifies claims with high recovery probability
NLP data extractions and OCR processing streamline claim determinations
Optimize payment error detection in real-time with client configurable rules engine in real-time to align to policy and guidelines
Client-specific content libraries
Transparent claim status insights, reports, and data analytics
Flexible SaaS, tech-enabled service, and hybrid solutions
AI-as-a-Service for Clinical Chart Review
Deliver AI-powered clinical and billing insights within your existing pre-payment clinical chart review workflows using our flexible AI services via API-driven integrations.
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Featured Resources
Build Consistency and Confidence in Your Chart Review Process with Apixio
Explore how Apixio can support your organization’s unique payment integrity program needs.