Service Areas

EquiClaim's Clinical Claim Review Services identifies and recovers meaningful savings primarily from previously resolved claims, although selected services can be performed pre-payment. Reviews are performed by a team of highly skilled professionals including field nurse auditors, pharmacists, DRG coding analysts and policy compliance specialists, resulting in identification and recovery of overpayments back to the client.

As national healthcare spending continues to outpace economic growth, healthcare payers are challenged to find innovative ways to manage and contain costs wherever possible. EquiClaim offers its customers a variety of cost containment solutions to accurately identify and recover overpayments through its Clinical Claim Review Services.

Capabilities
EquiClaim's Clinical Claim Review Services offering is designed to pinpoint and reduce billing and coding errors, cost-shifting practices and fraud and abuse after medical claims have been paid. EquiClaim has developed the specific audit expertise, analytical tools and effective protocols for reducing a payer's costs on already paid claims.

Summary
As a result of escalating healthcare costs, it has become necessary for payers to employ novel approaches to achieve cost savings. EquiClaim's Clinical Claim Review Services suite utilizes proprietary tools to identify billing errors that can often result in overpayments to providers. Armed with this information, payers have the opportunity to recoup costs after claims have been paid.