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Clinical Claim Review Services
Renal Dialysis Claims
EquiClaim, an Emdeon company, identified a significant need to review and recover overpayments specific to the renal dialysis industry. High-cost hemodialysis and peritoneal dialysis services become routine patient care. However, the variables in dosing and utilization of high-cost drugs associated with these services lead to complex billing, with great potential for drug unit billing errors and overuse of medication. EquiClaim, an Emdeon company, utilizes pharmacist and policy compliance auditors to carefully analyze previously paid claim files to identify cases that have a great potential for drug unit billing errors. EquiClaim, an Emdeon company, also analyzes patient history, billing and utilization trends to clinical protocols, validation of hematocrit and lab values supporting high dose cases when necessary, frequency of hemodialysis treatments, and billing of associated lab services.
RxI areas of focus include: