In some cases, a plan’s arrangement with its PPO or specific plan document language will preclude or make it difficult to review claims for usual and customary reductions. Given that 95% of the claims NBAS reviews contain some form of error, discrepancy or challengeable practice, NBAS’s Billing Error Review is the perfect solution for both in-network and out-of-network claims. NBAS performs a detailed, line-by-line analysis of the UB92/UB94 and corresponding itemized bill (and operative report if applicable) and identifies coding errors, inconsistencies, erroneous charges, discrepancies, unbundled charges and utilization.
NBAS uses numerous sources when reviewing claims to identify billing errors. Experienced coding professionals utilize nationally recognized standards to verify the hospital’s use of professional and in-patient codes. In addition to coding professionals, NBAS’s clinical team reviews claims for inconsistencies in pricing, discrepancies in utilization, atypical charges in relation to the diagnosis code(s) provided, and unbundled charges.