AmeriVeri CR effectively finds savings for clients of all types both large and small. Below are the highlights from several reports. Included are actual savings identified for an insurance company, TPA, and workers’ compensation administrator.
Insurance Company/Group Health Plan Savings Example
| Date Verified | 02/18/11 | |
|---|---|---|
| Range | 01/04/10 to | 01/25/11 |
| Total Claims Scrubbed | 15,397 | $5,899,139 |
| Average Claim Scrubbed | $383.14 | |
| Rejections | 458 | $192,536 |
| Rejection Percentage | 2.97% | 3.26% |
| Report Highlights | |
| Service Verification and Medical Necessity | 34.28% |
| NCCI Professional (INCL Category B) | 32.31% |
| Diagnosis Validation | 28.38% |
| Units – Professional | 5.02% |
Third Party Administrator/Fully Insured Savings Example
| Date Verified | 06/01/10 | |
|---|---|---|
| Range | 01/01/08 to | 12/15/09 |
| Total Claims Scrubbed | 22,182 | $3,766,643 |
| Average Claim Scrubbed | $169.81 | |
| Rejections | 684 | $185,618 |
| Rejection Percentage | 3.08% | 4.93% |
| Report Highlights | |
| Diagnosis Codes Invalid | 47.32% |
| Medical Necessity | 31.10% |
| NCCI Facility (Modifier Conditionally Allowed) | 7.14% |
| Required Information Missing | 6.75% |
| NCCI Facility (No Modifier Allowed) | 4.01% |
| Units – Professional | 1.81% |
| CPT Validation | 1.52% |
| HCPCS Validation | 0.19% |
| NCCI Facility (Modifier Conditionally Allowed) | 0.16% |
Workers’ Compensation Example
| Date Verified | 04/14/11 | |
|---|---|---|
| Range | 01/03/08 to | 04/01/11 |
| Total Claims Scrubbed | 30,495 | $2,028,206 |
| Average Claim Scrubbed | $66.51 | |
| Rejections | 619 | $81,309 |
| Rejection Percentage | 2.03% | 4.01% |
| Report Highlights | |
| Service Verification and Medical Necessity | 28.27% |
| Diagnosis Validation | 24.72% |
| NCCI Professional (INCL Category B) | 17.45% |
| NCCI Professional (INCL Category D) | 12.44% |
| NCCI Professional (ME Category B) | 6.14% |
| E Codes – Workers’ Compensation | 4.36% |
| Units – Professional | 3.72% |
| CPT Validation | 1.45% |
| HCPCS Validation | 1.45% |
