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Precision Claim Technology

Developed from over 25 years of experience, updated and edited daily and upgraded weekly by each of our department supervisors, Precision Claim Technology is much more than the 3rd party scrubbing offered by other vendors.

You don’t need us to tell you – if a claim is unpaid after its first submission, it is very costly and difficult to get it paid the second or even the third time through a payer’s system.  Our competitors rely on data-entry personnel to memorize a long list of rules and procedures, log into another long list of websites to follow-up claims, to add modifiers and to know which diagnosis goes with which procedure.  With Precision Claim Technology (PCT), we eliminate all known problems so a clean claim, precise with perfect information, goes through the first time.  Result?  You get paid.

Yes, PCT checks for hundreds of possible clerical errors (date of service after today, date of service before the patient’s dob, inappropriate diagnosis for patient’s age/sex to name only a few) but PCT also checks for:

  • 1,418,171 National Correct Coding Initiative Edits – alerts when modifiers may be necessary
  • 13,000 National Coverage Decisions – adjust Dx Pointers as needed
  • Over 8,000 Local Coverage Decision combinations – adjust Dx Pointers as needed
  • 8,134 CMS Medically Unlikely Edits (MUE)
  • 5,600 NDC requirements for drugs

Where we REALLY differ? Our edits also edit the claim in relation to other claims for that patient. We:

  • Check modifier appropriateness, i.e. a -25 modifier on a non-E/M code
  • Check for duplicate modifiers, i.e. using -76 and -77 on the same line
  • Cross-Check E/M site with facility code usage, i.e. cannot use Inpatient E/M when office is site of service
  • Check global fee period usage as it relates to prior surgical services
  • Check for providers being out of the office and possibly using Locums
  • Check for incident-to requirements on new patient visits and ensuring compliance with established patient visits
  • Check for narrative requirements on necessary codes, like JS420
  • Check for NDC# requirements
  • Check for missing guarantor’s information
  • Check age appropriateness for preventative CPT codes
  • Check for new patient time lapse requirements

And that is just the start.  We don’t want to reveal everything we’re doing, we know our competitors monitor our website, but our dedicated team builds and adds new edits daily and meets to discuss new payer patterns and preventable new denials weekly.

So, what does this mean to you as a Provider?  It means we have developed a very sophisticated technology to prevent denials without relying on a data-entry person to remember an enormous amount of information.  It means our claims go through.  It means you get paid – the first time.