Dynamic IT Healthcare provides a value-added service to TPAs/Payers that extends beyond the capabilities of traditional auto-adjudication software. We enhance pricing efficiency after billing by utilizing network discounts and repricing strategies.
In many cases, the medical necessity of certain services is questionable. These issues result in significant costs for payers, and incidents of abuse are increasing. When discrepancies arise between clinical documentation and coding (ICD-10/CPT-4 and HCPCS-II), they form the basis for our repricing and negotiation processes.
We also collaborate with providers to address issues such as unbundling and over-coding. Dynamic IT Healthcare has recognized that high-value services, including 4th and 5th level evaluation and management (E/M) codes and surgeries performed in the operating room, often lack necessary components, such as service duration documentation. We challenge these undocumented services with the support of our clinically qualified staff at Dynamic IT Healthcare.
Our clinical team reviews clinical documentation based on evidence-based medical practices, utilizing tools like InterQual criteria and the Milliman Care Guidelines (now known as MCG) to conduct thorough utilization reviews.