EN | ES

Clean Claim Reviews

Our clinical expertise and service-first approach to comprehensive claim reviews ensure claim accuracy and industry leading savings.

CCR_1519064576nobkgrd-BWweb

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.

Other Solutions

Reference-Based Pricing

A data-driven approach to determine fair and acceptable healthcare reimbursements.

Out-Of-Network

Our Out-Of-Network solution provides health plans with significant cost savings for non-network claims.

Transplant & Specialty

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.

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
Mask Group 47

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.

CCR_144337669web

See the Savings!

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

The Benefits of Our Clean Claim Reviews

We have repriced over 700k claims and achieved total savings over $171M! Our customers appreciate the benefits of:

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 Review!

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

"*" indicates required fields

State*
Consent*