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Clinical Claim Review Services
Inappropriate Admission Review (IAR)
Inappropriate Admission Review identifies inpatient claims with a high potential for overpayment, based on the level of care, severity of illness and intensity of service provided. EquiClaim, an Emdeon company, employs certified InterQual instructors, certified case managers and utilization review professionals that review medical records and document unsupported admissions for overpayment recovery. IAR cases undergo a unique data mining routine that looks for potential inappropriate admissions, as well as potentially non-covered services that may be medically necessary.
Policy Compliance Review areas of focus include: