Medical Billing Services Company

Pre-Adjudication Services

Identifies avoidable denials prior to submission – reducing errors and time for payment.

Rely's unique web-based pre-adjudication system increases profitability by identifying avoidable denials and recommending solutions before claims are submitted to payers. RELY’s All Payer solution utilizes a Rules Based Engine and a proprietary database to target potential denials or delays in payment with payer specific insight on how to minimize uncompensated treatments.

• We import your claims - uploaded to our secure message center as attachments
• Avoidable denials and solutions are reported to you via the web
• Reviewed and corrected claims are submitted electronically to payers

The pre-adjudication process will review and validate:

• Policies Respecting the Reimbursements of Supplies
• Policies Respecting Multiple Procedures Performed on the Same Date of Service
• Definitions of “Medical Necessity” and “Medical Necessary”
• Clinical Policy
• Fee Schedule Information
• Claim Bundling Logic
• Relationship Among Billing Codes
• CPT-HCPCS/ICD-9
• Crosswalk Table
• Miscoding Edits
• Diagnosis Edit Tables
• Modifier Edit Table
• HCPCS Modifier Table
• Procedure Edit Table
• Multiple Procedural Edits
• Place of Service Edits
• No Surgical Assistant Required Edits
• Prior Approval Edit
• Maximum Frequency Per Diem Edits
• Global Period Edits
• Unbundle Edits
• Rebundle Edits

 For more information on this contact us…