Claims Review Services You Can Count On
Certain elements of payment integrity can be validated only with the review of records, contract matching, or other unique processes. JAG offers services that enhance medical and administrative cost control and ensure the highest level of payment integrity.
DRG and Short Stay Claim Validation
JAG’s claims review services ensure the coding and payment accuracy of inpatient hospital DRG claims. We use proprietary algorithms and the clinical expertise of our staff doctors, nurses, and coding experts to provide a superior selection and audit process that can reliably identify miscoded claims. We look for potential errors within inpatient DRG claims, assure payment claim accuracy, and generate repeatable, defensible results for our clients, allowing you to manage escalating medical costs better.
Short-stay claims are typically defined as inpatient claims with a longer stay of two days or less. JAG’s review process determines that these patients meet inpatient medical necessity criteria based on medical record documentation.
In addition to inpatient claims analysis, JAG’s team of professional analysts leverages our clinical expertise and ongoing reporting and metrics capabilities to provide clients with business decision support services.
Payment Policy Management Services
JAG is a national leader in payment policy and integrated claims management. JAG partners with clients to customize and configure payment policies for professional and inpatient facility claims. We help our clients develop a comprehensive, rule-driven, and defensible payment policy that allows them to pay claims accurately.
Our approach to developing an effective payment policy utilizes the industry’s most comprehensive sources of correct coding and medical content.
Through JAG, clients can:
- Select a clinically appropriate payment policy that corresponds with the client’s strategy.
- Tailor the policy application to specific markets, lines of business, and provider types.
- Apply the payment policy accurately and consistently.
- Better manage escalating medical costs.
- Significantly increase operational efficiency through our consulting knowledge and business practices.