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Panacea Offers Focused Audit Service in Response to United, Anthem and other Payer Attempts to Reduce Level 4 and 5 Reimbursements

Lehi, Utah, April 20, 2018 – In response to recent initiatives from United Health, Anthem and other Payers, Panacea announced a service for providers to proactively identify their financial risk.

 Specifically, for patient claims coded as Emergency Department Level 4 and higher, Panacea will utilize its state-of-the-art CLAIMSauditor® technology and clinical coding experts to help healthcare organizations stay a step ahead.

The CLAIMSauditor system, which is used by hospitals and health systems for compliance, coding, and revenue integrity, will apply rules against historical claims data to find claims having ED Level 4 and 5 codes for patients sent home after that visit. Additionally, CLAIMSauditor rules will include criterion that considers the patient’s medical issue, comorbidities and the diagnostic services performed during the ED visit to determine what payers may believe is the appropriate code

“The system will flag records that meet specific criteria and categorize them into high, medium and low probability of being at risk,” said Mark Spehar, Panacea Senior Vice President of Financial Services. “Those records selected as having medium or high probability can be reviewed by Panacea’s consulting team or by the providers’ own staff.”

CLAIMSauditor can also apply rules to ED Level 1,2 and 3 cases to identify the extent to which documentation or coding issues may have improperly fallen into a lower paying payment category.  Payer rules for audit selection typically focus on over coding and over billing which is why CLAIMSauditor is an important tool for healthcare organizations to proactively uncover both risk and offsetting net revenue opportunities.


Contact: Marilyn Bunderson

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