This service is the healthcare industry’s answer to the threat of government and third party claims audits. The CAIN staff of utilization review nurses, certified medical coders and physicians review medical record documentation for medical necessity, documentation and coding issues. This program includes a proprietary process management system which tracks all aspects of the audit process, assuring that all steps are addressed in a timely fashion. Appeals are aggressively pursued by our clinical staff and targeted education programs are developed and presented to minimize future audit exposure.
- NetworkOver 100 Utilization Review Nurses and Case Managers and over 250 Physicians representing 75 specialties
- Protect Yourself In 2012, an estimated $19 billion of the federal Medicaid funds were absorbed by improper payments, which include fraud and abuse as well as unintentional mistakes such as paper errors.