Trust our medical and claims reviews to protect your payments and systems.
Uncover risks. Protect your organization. Save money. Team up with Qlarant for medical and pharmacy record reviews — to explore and detect billing, compliance, quality of care, and fraud, waste and abuse issues.
We’re experts in collaborating to assure correct payments and address fraud, waste and abuse situations. Our people know where and how to look effectively. Our process is focused on reaching a successful conclusion effectively without compromising the quality of the review.
It starts with our experienced team of nurse investigators and certified coders. They’re up to date on compliance, regulations and rules — and trained to identify potential fraud and overpayment in Medicare and Medicaid in all states.
They’re also seasoned in reviewing for claim invalidity based upon misrepresentation of the service — such as up-coding, unbundling, or incorrect place of service, and in technical denials including missing plans of care or required signatures.
During the review process, our people are careful to exercise accurate and defensible decision making, ensuring sustainability of any findings. Qlarant technology solutions support our efforts, going beyond automated reporting capabilities to track reviews, calculate claims and error rates, and deliver documentation.
And we’re prepared to partner with you at any level. We can notify billing entities of findings, make appropriate referrals to provider outreach and education, and collaborate with legal teams, law enforcement partners and agencies.
Put our expertise to work safeguarding your payment system. Quality. Clarity. Opportunity.TM Talk to a Qlarant medical review expert today.