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All submitted claims are "repriced" before they are paid. A multi-tiered methodology is used to evaluate these claims to ensure consistent and defensible repricing of said claims. Inpatient bills are reviewed at the revenue code level utilizing the national standard cost accounting method for hospitals and identify appropriate reimbursement. Outpatient bills are repriced utilizing HSI’s proprietary database. This system can reprice all charges at each payors pre-specified percentile. An explanation of the repricing calculation accompanies all provider reimbursements.
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