Our Process
Error rates in healthcare range from 1-3%. Our proprietary, painless claims audit platform uses an automated system to identify more issues, more quickly, focusing on:
Benefits
Patient portions, benefit limits, noncovered services
Duplicate claims
Traditional duplicate claims, duplicate lines, overlapping inpatient claims
Coordination of Benefits
Missed coordination opportunities and errors with Medicare, commercial and secondary plans
Pricing
Contracted rates, out-of-network limits, cost containment provisions, modifier discounts
Eligibility
Retroactive terminations, errors in eligibility information, dependent eligibility verification
Medical edits
Detailed coding rules including unbundled procedures, mutually exclusive procedures, unit count errors, diagnosis/procedure mismatch
What Clients Say
John worked closely with us to understand our specific claims audit requirements, bringing JGI’s expertise to the table, making for a better review process. Their team was very thorough, and the output was exactly what we were looking for. Several opportunities for improvement were identified, and we could not be happier with the results. We expect to engage with JGI again in the future.