Inmate Medical Claim Edits

Advanced Tech Built On Experience

For jail administrators and sheriffs who are interested in maximizing savings on medical claims, we offer our state-of-the-art, seamless claim review technology that delivers maximum savings on inmate off-site medical claims.

Each claim is audited or “scrubbed” down to a clean claim by removing billing errors such as duplicate charges or codes that cannot be billed together. For example, if the diagnosis is for a broken finger, but there is a procedural code for a broken toe, our system will remove (or deny) those charges. This advanced technology is rigid on coding parameters and relies upon our health care expertise built over decades.

Knowledgeable Professionals

When it comes to claim review and editing, our technology is only half the story. Our knowledgeable and experienced in-house professionals leverage data and automated processes to complete timely, accurate reviews that focus on the claim audit process. After the audit is complete, our team of professionals apply a negotiated discount either automatically through our preferred provider (PPO) network or a one-time LOA. As a result, county jails realize accurate and maximum savings.

What if you could be more knowledgeable about inmate medical costs that the county must pay?

Not only does our inmate medical cost containment program save the county money on off-site medical costs, our program features strong reporting capabilities to arm you with the knowledge you need to better manage. We provide monthly reports with the total number of claims and total savings based on the month or year-to-date.

These monthly reports allow you to be truly accountable and knowledgeable about inmate medical costs that the county must pay. When anyone asks you how much you save on off-site medical you will have that information readily available on your most recent report. Having a cost management system shows that the county is focused on providing appropriate medical care regardless of the cost.

Be confident you are charged the right amount for inmate medical care.

Our team of specialists can analyze claims as they come in and confirm the contracted rates for the medical services delivered, in addition to spotting duplicate billings, correct coding edits needed to process the bill, and potential discrepancies. We understand the nuances of claims payments and how time intensive it is to stay on top of inmate medical bills, current medical codes, and payment based on contracted rates. Our process removes the burden from you, saving you time and money.