We’ve Done The Heavy-Lifting So You Won’t
Have To.
We’ve built our integrated domain-specific platform to make it easy and more affordable for you to provide exemplary value to your clients so you can grow your business faster. We encourage you to innovate and scale quickly without duplication of efforts and without any development investment or administrative effort.
Customizable Payment Integrity Platform
An open and customizable Payment Integrity platform that empowers your Payment Integrity specialist team, powered by our domain-specific language, CREOLTM
Create, customize, and release concepts based on varied customer needs with the power to release at any time without technical dependencies.
Up-to-date pre-configured code sets and industry payment policies with rule rationale.
A repository for storing and managing all of your IP payment policies with complete protection and without duplication of efforts for each payer.
A platform that empowers domain experts to ideate, create, validate, test, and implement rules and new concepts on the fly without high technical dependency. Pull claim fields to find patterns with SME’s innate knowledge.
Single location for all of your daily Payment Integrity activities.
Ideation Platform
A platform that empowers domain experts to ideate, create, validate, test, and implement rules and new concepts on the fly without high technical dependency. Pull claim fields to find patterns with SME’s innate knowledge.
“What if” Scenario
Ability to identify and create new savings opportunities and test their impact on historical claims data. Create proprietary policies faster.
Impact Analysis
Measure the Rules Edits vs Savings at various thresholds before finalizing and publishing a customized rule
Data Mining and Analysis
SMEs are equipped with the power to play and try out different concepts.
Query
Query across different claim data fields and in combination, quickly.
API-First Platform
FHIR-Compliant APIs.
Verify claims with our APIs (include up-to-date Industry payment policies for Medicare, Medicaid, and commercial lines of business).
Use our on-demand customization of policies and run the claims by sending them with our API.
Auto-updated standard Medical Code sets APIs.
Dashboard and insights based on API utilization across time periods and numerous other parameters such as edits, service, claim types, etc.
Missed billable charges
You deserve to get paid for the care you provide, so ALL billable events must be captured into charges and result in payment. Often providers lose significant potential annual net revenue due to missed charge capture.
Increase Revenue Opportunities
CoverSelf’s Platform calls out missed billable charges that routine edits would
Industry
Benchmarks
Identifies the missed billable charges based on industry and specialty
Episode
Grouper
The Platform suggests possible missed billable charges using
Customized Billing Methodology
Receive customized alerts specific to your billing methodology and patients’
Payer Partners
Customizable Payment Integrity Platform
An open and customizable Payment Integrity platform that empowers your Payment Integrity specialist team, powered by our domain-specific language, CREOLTM
Create, customize, and release concepts based on varied customer needs with the power to
Up-to-date pre-configured code sets and industry payment policies with rule rationale.
A repository for storing and managing all of your IP payment policies with complete protection
Single location for all of your daily Payment Integrity activities.
Ideation Platform
A platform that empowers domain experts to ideate, create, validate, test, and implement rules and new concepts on the fly without high technical dependency. Pull claim fields to find patterns with SME’s innate knowledge.
“What if” Scenario
Ability to identify and create new savings opportunities and test their impact on
Impact Analysis
Measure the Rules Edits vs Savings at various thresholds before
Data Mining and Analysis
SMEs are equipped with the power to play and try out different
Query
Query across different claim data fields and in combination, quickly.
Provider Partners
Denial Prevention and
Revenue Optimization
Our Denial Prevention Solution has a robust and customizable Rules Library that increases your clean claims rate at the first pass. It also identifies missed
A robust Policy Library (professional, facility, DME) that automatically reviews claims to
Flexibility to personalize edits that better suit your organization’s needs based on your billing
Discovers billable opportunities that were not captured in coding or charge entry, increasing
Validates Inpatient claims based on ICD-10-CM/PCS and UHDDS guideline edits, alerting for
Denials Management
A fully managed platform that enables effective denial management prioritizes and monitors claim performance and financial outcomes and reduces denials through the use of continuous feedback loops.
Denials Management to Denials Prevention
Our Platform allows you to derive insights from current denial trends and configure
Root Cause Analysis and Education
Comprehensive drill-down analyses help to trace root causes to fix issues
Underpayments
Identifies and alerts underpaid claims with no false positives
Provider Utilization & Education
Provides insights on Provider billing, denial trends, and provider
API
API-First Platform
FHIR-Compliant APIs.
Verify claims with our APIs (include up-to-date Industry payment policies for Medicare,
Use our on-demand customization of policies and run the claims by sending them with our API.
Auto-updated standard Medical Code sets APIs.
Dashboard and insights based on API utilization across time periods and numerous other
Missed billable charges
You deserve to get paid for the care you provide, so ALL billable events must be captured into charges and result in payment. Often providers lose significant potential annual net revenue due to missed charge capture.
Increase Revenue Opportunities
CoverSelf’s Platform calls out missed billable charges that routine edits would
Industry
Benchmarks
Identifies the missed billable charges based on industry and specialty
Episode
Grouper
The Platform suggests possible missed billable charges using
Customized Billing Methodology
Receive customized alerts specific to your billing methodology and patients’
Key Differentiators
Domain-Specific
Platform With
Build Your IP
Rapid customization and launch option
Access to Rule
References
API
