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Focused Claims Review

Ensure billing accuracy of professional claims.

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Cost savings found in the details

Focused Claims Review (FCR) is an innovative payment integrity approach targeting procedure and surgery claims. Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.

Focused Claims Review Professional

Focused Claims Review Professional targets procedural and surgical claims with the greatest potential yield and a discrete number of providers with atypical billing patterns. 60 to 75% of targeted claims reviewed show errors, saving clients 14 to 28% of total claims dollars reviewed.*

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Incremental

Defined savings not found by automated programs

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Targeted

Minimum claims reviewed for maximum savings yield

Sustainable

Always refining targets saves long-term costs

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*Savings represent cost reductions from the total claims dollars reviewed. Based on analyses including pre-sale assessments and OrthoNet performance metrics representing blended average experience across program’s book of business 2006-2018. Average savings based on average weighted spend under management and scope of specialties and procedures reviewed.