Our solutions for adjudication and claims re-pricing include verifications such as eligibility of membership, and the provider contract verification that is generally necessary for claims processing. We also specialize in the data entry of claims information, and our trained data analysts and data entry personnel have a very high level of accuracy, supplemented by the claims audits that we perform on an ongoing basis to ensure all entries are fully in compliance with current standards.

When you are running millions of transactions through a technology system every year, you need to know that the platform is stable, secure and easy to use. Our data structure has been tested and proven successful over a period of several years, and we focus on a high level of accuracy as well as an excellent turnaround time for every transaction that our clients pass through to us.

Our data teams can work on electronically submitted data sheets as well as on scanned images, and they are especially aware of the various regulations and rules that are specific to individual states and counties within the U.S. Our flexible platforms allow Novigo to place effective charge control measures in place based on your business rules, and we process charges for multiple specialties. You may receive daily reports with no pay, low pay information and denials are worked on a priority basis.

Our goal is to constantly keep you in the loop with the information that you need to make solid business decisions that will help you take your business to the next level. Our Quality Assurance team continually audits data to ensure that data entry teams provide the highest quality output possible.

Inappropriate and incorrect payments can cost you hundreds of thousands of dollars per year, and our Claims Audit solutions are designed to help Healthcare Payers reduce or ultimately prevent these payments. Our business rule engines help track accuracy and identify challenges before they are finalized, negating the necessity for payments. The goal of these specific systems is to reduce billing costs and pinpoint errors in coding that may occur. Our historical claim data is constantly flowing through our detection engine in order to ensure all services comply with billing rules and to identify the data that is non-compliant. Claims that require additional review are identified and routed through an exception handling process.