HealthHelp’s effective claims-review program, CodeRight, ensures correct provider billing and payment. It identifies claims paid inappropriately or in error and the associated sums for recovery. CodeRight reviews claims for all radiology procedures including diagnostic imaging, radiation oncology, cardiology, and interventional radiology. It also incorporates local-area coverage decisions relevant to each of HealthHelp’s clients. In addition, CodeRight provides policy recommendations for paying future claims that reflect changes in technology and medical practice. This helps payers develop sound payment policies and identify providers who bill outside established norms. Unlike competing programs, CodeRight offers a variety of flexible implementation options. For example, claims can be individually reviewed in real-time with instant feedback or they can be batch processed with twenty-four-hour turnaround. And CodeRight can be quickly and conveniently run remotely through HealthHelp’s system or loaded directly onto payers’ own claims editing systems. Often, savings from CodeRight alone cover the entire cost of the integrated HealthHelp program.
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