Published on October 23, 2013 at 2:36 AM
DataMetrix's newly released technology platform, CASE™, provides the industry with the ability to audit claims for payment accuracy through the integration of a fully automated rules engine with sub-second response capability and a proprietary format which triages claims targeted for in-depth clinical review.
The industry is confounded with a plethora of diverse services and technologies which aim to ensure the correct payment of claims. These offerings include both pre- and post-pay deployments, facility and physician-based services, and automated as well as manual processes. These are further supported by voluminous libraries of public and private edits, payment policies, fee schedules and complex provider specific reimbursement contracts. Management of these disparate systems is administratively burdensome, inefficient and costly.
"CASE™ provides a single platform which seamlessly integrates these functions within its design to include selection, processing and reporting databases. CASE™ is highly scalable and is offered as SaaS," says Gary Twigg, CEO and President of DataMetrix. He adds, "Currently, CASE™ operates in supervised mode, which is table driven. However, in early 2014 DataMetrix will introduce an unsupervised mode which is largely data driven."