CNO Associates

AUDITING HEALTH CARE CLAIMS FOR: •Commercial Plans •Government Plans: Medicare, Medicaid, SCHIP •Medicare Advantage •Third Party Administrators •Self-Funded Plans COMPREHENSIVE AUDIT In today's dynamic healthcare market, you need an Overpayment Identification solution that goes beyond claims processing software and helps you respond quickly and effectively to the changes that are driven by government regulations, provider billing compliance, and the complexity of healthcare claims. CNO will audit 100% of claims to identify payment errors: Medical, Hospital, Pharmacy, Behavioral Health, Dental, DME, COB, Subrogation and more. Each error category is documented with every error we detect. This extra step provides checks and balances to the process to ensure our edits match your claim payment rules. Clients can further use the documentation to train analysts, update claims payment policies, answer provider inquiries, and document claims adjustments. We audit 100% of claims and group individual payment errors into categories. Common categories include: Procedure Unbundling, Mutually Exclusive Procedures, Multiple Medical Visits on same Date of Service, Bilateral and Duplicate Procedures, Pre and Post Operative Care, Assistant Surgeon, Cosmetic Procedures, Modifier Errors, Coordination of Benefits and Subrogation Payment Errors, Professional/Technical Component Errors, Outpatient services that should be included with Inpatient charges, Discharge Code errors, Grouper errors, Overlapping services and fragmented billing, and more.