Clean Claim Reviews
Our clinical expertise and service-first approach to comprehensive claim reviews ensure claim accuracy and industry leading savings.
What are Clean Claim Reviews
Clean Claim Reviews are part of the Payment Integrity program that provides detailed clinical reviews of inpatient hospital billing and includes management of claims through resolution and appeal activities with providers. Payment integrity is about adherence to standard billing practices and accountability at every level; to identify and eliminate errors or inconsistencies and ensure claims are paid accurately the first time.
Clean claim reviews can be implemented in tandem with a reference-based pricing reimbursement model, but they can also be used as a standalone service. In a network setting, clean claim reviews are essential for reducing high-dollar catastrophic inpatient claims spend.
A data-driven approach to determine fair and acceptable healthcare reimbursements.
Our Out-Of-Network solution provides health plans with significant cost savings for non-network claims.
Let us expertly navigate the contracting and reimbursement process for your most expensive and complex procedures.
Why are Clean Claim Reviews Important?
Clean Claim Reviews are paramount to ensuring fairness and transparency through payment integrity.
100% of Inpatient Claims Have Billing Errors and
6 Degrees Health Saves an Average of 10% or More Per Claim!
There is also a significant discrepancy in billing across hospitals – without clean claim reviews, health plans and patients can be overcharged, contributing to billions of dollars in waste for the healthcare system.
Below are examples of price discrepancies from different hospitals in the same region.
- ICU Room and board – $60,000/day
- Daily ventilator management – $5,400/day
- Pulse oximetry monitoring – $2,230/day
- Blood administration – $4,200/episode
- ICU Room and board – $31,000/day
- Daily ventilator management – $1,800/day
- Pulse oximetry monitoring – $950/day
- Blood administration – $2,200/episode
- ICU Room and board – $38,000/day
- Daily ventilator management – $2,750/day
- Pulse oximetry monitoring – $1,550/day
- Blood administration – $3,000/episode
The 6 Degrees Health Difference
6 Degrees Health takes a service-first approach to our Clean Claim Reviews to ensure accuracy in billing and fair payments. Using our extensive cost containment experience and clinical expertise, we conduct the reviews in accordance with industry standard guidelines and evaluate every line item to identify and remove billing errors and inconsistencies.
Our clinical reviews are completed by registered nurses to ensure each billed line item, including routine supplies and services, pharmacy charges, laboratory, level of care, and implants are correct. This detailed review removes erroneous line items and verifies billing accuracy. The Clean Claim Review process identifies errors on the claim which cannot be balance-billed to the member and may also help reduce stop-loss premiums.
Our comprehensive process manages claims during the review stage, as well as through payment, resolution, and appeals. Simply by leveraging our pre-payment reviews for healthcare services already rendered, you can see incredible savings.
The Benefits of Our Clean Claim Reviews
Decipher complicated hospital bills: routine supplies, nursing services, capital equipment, operating room
Adjust egregious drug mark-ups, duplicates, overages
Fix the mismatch between billed revenue code and resource consumption
Ensure accuracy: off-label drug use without proven safety or efficacy are considered experimental or investigational and not covered most health plans
Correct claim defects not addressed by contracts
We work with providers to answer questions and settle disputes.
Submit a Large Claim for Review!
Payers, send us a claim over $100,000 and we will show you how much you could save!
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