Start with the source
Use current primary payer or program instructions. Keep the section and the date it was checked.
Our evaluation method
A requirement needs
a source and a scope.
A useful finding explains which instruction applies, what evidence supports it and what the reviewer should investigate.
Confirm applicability
Check payer, program, jurisdiction, service, claim format and effective period.
Keep the decision
Document the evidence, uncertainty, reviewer decision and next action.
What makes an alert useful?
It identifies a concrete question and the evidence needed to resolve it. A review should also recognize when a check is duplicated, an alert is false or the information is unavailable.
Explore issue categories →A few useful answers
Before you take the next step.
Does a passed check guarantee payment?
No. A check addresses a defined requirement. Adjudication, coverage, documentation and other factors still affect payment.
How should we evaluate additional checks?
Compare with the current process using equivalent scope. Count useful findings, duplicate checks, false alerts and unavailable evidence, as well as the work needed to review them.
Start with your workflow
Make the next billing decision
with a clearer picture.
Build a short action plan, or talk to us about your payer and process.