For payment integrity, the first real question is whether the claim is diagnostically supported by the medical record. Cavo Payment Integrity’s unique Precise Word Matching AI will answer that question in milliseconds.
Cavo Integrity’s Precise Word Matching AI uses millions of “queries”, that is, collections of words that confirm the presence of a specific ICD, to thoroughly search every page of the medical record for specific ICDs. If this technology cannot find diagnostic evidence for a claim, you can be virtually certain that the claim is in error.
If the claim has diagnostic support, the next question is whether the procedure or treatment was medically necessary according to CMS standards. Cavo Payment Integrity will tell you that also – in milliseconds.