How It Works

Software as a Service

AmeriVeri identifies miscoded medical claims before payment is issued. Individual claim lines that contain errors are recommended for non-payment. In order for a provider to be paid for their services a claim must be resubmitted. Whether a claim is resubmitted correctly, incorrectly, or not at all varies by provider and follows no pattern.

Note: If the resubmission rate is high, we ensure the accuracy of a significant number of claims. If the rate is low, we save significant money for employers and payers.

Workflow

Claims are transmitted to and from AmeriVeri via SFTP in any format.
The entire data transmission and return process is fully encrypted, takes less than an hour, and can be configured at any one of the three points shown below:
By providing seamless non-payment recommendation and reason code transmission, AmeriVeri enhances current processes rather than replacing them and creates an additional opportunity to take action on frequently miscoded claims.

Return Items

Data Feed: Data sent back to the client is tailored to preferred format. (e.g. 837, comma delimited, etc.) This format does not have to match incoming format.

Reports: Line by line details that include reason codes and descriptions accompany every return data file.These reports can be customized for individual clients.