CERiS Offers First Prepayment Dual Reviews For Payment Integrity Programs

Rhea-AI Summary

CERiS, a division of CorVel Healthcare, has launched enhanced prospective claim review services for clients paying medical claims. This new offering features comprehensive reviews for itemized bills and DRG validation, with a track record of correcting billed charges. CERiS utilizes advanced technology like AI and machine learning to ensure payment integrity. As a publicly traded company, its independent operations stand out in a consolidating market, with a strong commitment to growth and investment in innovative systems.

Positive

• Launch of comprehensive prospective claim review services.
• CERiS has a strong track record in correcting billed charges.
• Utilization of AI and machine learning enhances service efficiency.
• Independent ownership allows for unique positioning in a consolidating market.

Negative

• None.

Itemized Bill Review and DRG Validation Are Performed by a Division of a Publicly Traded Company, Independent from Ongoing Market Consolidation

FORT WORTH, Texas, April 19, 2021 (GLOBE NEWSWIRE) -- CERiS, a division of CorVel Healthcare and a leading national provider of cost containment solutions, now offers a comprehensive prospective claim review services for client firms that pay medical claims. The expanded service produces the most complete and accurate review available for both itemized bills and DRG (diagnostic-related groupings) validation.

“Our itemization review already has the industry’s best track record for correcting billed charges,” noted Corey Albrecht, President of CERiS. “For claims that pay a DRG base rate or an outlier payment and/or have carve-out language, we’re the first firm to deliver a complete package by offering full DRG validation review,” Albrecht remarked.

CERiS’s dual reviews validate coding on the DRG base rate and simultaneously perform an itemization review to identify disallowed charges on the outlier payment. All reviews are completed within prompt payment requirements with this turnkey prepayment review before they’re paid.

CERiS’s independent ownership and amicable, decades-long, relationship with medical providers contribute to its success in obtaining itemized bills and medical records for review. CERiS’s technology reduces provider friction while verifying payment integrity and delivering industry-leading results to health plans and TPAs.

In an industry where insurers are acquiring similar claims review operations, CERiS is unique in that it is independently owned by a 30-year-strong public company, CorVel Corporation. CERiS’s solutions utilize CorVel’s pioneering AI and machine learning for automation and predictive analytics to deliver efficient prepay solutions for payment integrity programs.

CERiS is at the forefront of the transition to prepayment solutions with the ability to review all claim types across commercial and government business.

“CERiS is aligned with CorVel’s long-term view of success, and we’re committed to achieving substantial growth for our payment integrity operations over the coming decade,” said Albrecht. “We’re continually investing in new systems and services to keep our customers on the leading edge of marketplace transformations.”

About CERiS
CERiS, a leader in both prospective and retrospective claims review and repricing, combines clinical expertise and cost containment solutions to ensure the accuracy and transparency in healthcare payments. Accuracy and validation services include itemization review, DRG validation, facility repricing, contract and policy applications, review of implants and devices, and primary payer cost avoidance. Its universal chargemaster contains billions of charge items from more than 97% of the nation’s hospitals, helping to ensure the accuracy and objectivity of each claim review.

About CorVel
CorVel Corp. applies technology including artificial intelligence, machine learning and natural language processing to enhance the managing of episodes of care and the related health care costs. We partner with employers, third-party administrators, insurance companies and government agencies in managing worker’s compensation and health, auto and liability services. Our diverse suite of solutions combines our integrated technologies with a human touch. CorVel's customized services, delivered locally, are backed by a national team to support clients as well as their customers and patients.

Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995

All statements included in this press release, other than statements or characterizations of historical fact, are forward-looking statements. These forward-looking statements are based on the Company’s current expectations, estimates and projections about the Company, management’s beliefs, and certain assumptions made by the Company, and events beyond the Company’s control, all of which are subject to change. Such forward-looking statements include, but are not limited to, statements relating to the Company’s network solution services and the Company’s continued investment in these and other innovative technologies, and statements relating to the Company’s strategic alliances within the healthcare market. These forward-looking statements are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause the Company’s actual results to differ materially and adversely from those expressed in any forward-looking statement, including the risk that the impact of the COVID-19 pandemic on our business, results of operations and financial condition is greater than our initial assessment.

The risks and uncertainties referred to above include but are not limited to factors described in this press release and the Company’s filings with the Securities and Exchange Commission, including but not limited to “Risk Factors” in the Company’s Annual Report on Form 10-K for the year ended March 31, 2020 and the Company’s Quarterly Report on Form 10-Q for the quarters ended September 30, 2020 and December 31, 2020. The forward-looking statements in this press release speak only as of the date they are made. The Company undertakes no obligation to revise or update publicly any forward-looking statement for any reason.

Contact: Melissa Storan
Phone: 949-851-1473
http://www.corvel.com

 

FAQ

What is the new service offered by CERiS for CRVL?

CERiS has launched comprehensive prospective claim review services for medical claims, focusing on itemized bills and DRG validation.

How does CERiS ensure accuracy in medical claim reviews?

CERiS utilizes AI and machine learning technologies to enhance accuracy and efficiency in its claim review services.

What is the significance of CERiS being independently owned for CRVL?

Being independently owned allows CERiS to operate uniquely in a consolidating market, differentiating it from competitors.

What future plans does CERiS have according to the CRVL press release?

CERiS is committed to substantial growth in payment integrity operations and plans to continue investing in new systems and services.