Validate clinical orders against payer rules for better claims results
The road to clean claims starts with mapping a strong Medical Necessity course. And staying on course means following the rules of the road, starting with payer rules and including evidence-based clinical standards of care.
The ultimate destination—financial gains and improved efficiencies.
Experian Health's Medical Necessity is the best road to clinical revenue protection. Interfacing with multiple information systems, it seamlessly and automatically checks patient orders against payer rules for medical necessity, frequency, duplication, modifiers and more.
The solution validates an order throughout the process to produce a clean claim billed without fear of denial.
Medical Necessity integrates seamlessly with all EMR, scheduling, and registration systems. Updates are performed automatically and continuously from the charge master file.
Proactively correct claims before submission to decrease denial rates and increase reimbursements.
Submit claims sooner in the billing process, streamlining your processes.
Receive automated alerts based on Medicare and commercial payer rules.
Connect directly with your registration and order systems, integrating seamlessly into existing workflows.