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Payment Integrity

Our clean claim reviews leverage clinical expertise, cutting edge proprietary technology and a service-first approach to drive comprehensive claim reviews and ensure claims are accurate prior to payment.

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What Are Clean Claim Reviews

Clean Claim Reviews, also referred to as itemized bill reviews (IBR), are a component of our Payment Integrity program that provide detailed clinical reviews of inpatient hospital claims and include full support through disputes and appeals 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.

 

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Explore insights and predictions for the future of the Payment Integrity industry with Katy Brant in her exclusive interview, and solve your high dollar claim challenges today.

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Why are Clean Claim Reviews Important?

Clean claim Reviews are paramount to ensuring high dollar inpatient claims are paid accurately to reduce waste in our healthcare system and the trillion-dollar annual hospital spend in the US.

100% of Inpatient Claims Have Billing Errors and
6 Degrees Health Saves an Average of 15% 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.

A
Chargemaster A
  • ICU Room and board – $60,000/day
  • Daily ventilator management – $5,400/day
  • Pulse oximetry monitoring – $2,230/day
  • Blood administration – $4,200/episode
B
Chargemaster B
  • ICU Room and board – $31,000/day
  • Daily ventilator management – $1,800/day
  • Pulse oximetry monitoring – $950/day
  • Blood administration – $2,200/episode
C
Chargemaster C
  • 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

At 6 Degrees Health, we put our clients’ needs first. Our expertise provides the highest level of savings in the industry with comprehensive support and defensibility. Our Clean Claim Reviews leverage state-of-the-art technology to deploy proprietary rules, which enhance our in-depth registered nurse reviews. We conduct our reviews in accordance with industry standard guidelines, evaluating every line item to identify and eliminate billing errors and inconsistencies. Our comprehensive process manages claims from the review stage through payment and appeals resolution. We can implement quickly, with or without data feeds, to meet our clients’ savings objectives within weeks.

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See the Savings!

Payers, send us one of your large, individual claims and we will show you the difference of our Payment Integrity Solution.

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The Benefits of Our Clean Claim Reviews

Unbundling Services

Decipher complicated hospital bills: routine supplies, nursing services, capital equipment, operating room

Billing Errors

Adjust egregious drug mark-ups, duplicates, overages

Level of Care Review

Fix the mismatch between billed revenue code and resource consumption

Plan Benefits

Ensure accuracy: off-label drug use without proven safety or efficacy are considered experimental or investigational and not covered most health plans

Advocacy

Correct claim defects not addressed by contracts

Appeals and Dispute Resolution

We work with providers to answer questions and settle disputes.

Submit a Large Claim for a Free Review!

Payers, send us a claim over $100,000 and we will show you how much you could save!

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