Appropriateness for Claims
Compass systematizes the technology applied to code validation use on claims that has too often been left for manual review by medical professionals. Beacon has designed Compass to precisely analyze all incoming claims for compliance and accuracy from a medical billing and coding appropriateness standpoint. The system flags claims that attempt to bill incompatible or unnecessary procedures, performing checks for medically unlikely or unnecessary combinations of edits, along with a host of other checks for reasonableness. Controls for code edit values allow you to deny, pend, ignore, or fire an alert for incoming in- and out-of-network claims. When necessary, the system will examine claim history for code verification.
- Identifies services that may have inappropriate, unnecessary or incompatible codes
- Includes checks for age and gender appropriateness
- Validates for expired or non-existent codes
- Automatically denies or pends claims to smart workflow queues that you choose
- Automates code edits without the use of doctors and nurses
- Allows you to devote your time away from manual review to more strategic efforts
- Improve auto-adjudication rates and claim payment accuracy
- Dramatically increase savings on affected claims
Compass provides significant claim savings and increases end-to-end efficiency, allowing you to spend less time on manual workarounds and more time with your customers.
|Compass Code Edits offers up to 58% claims savings on affected claims|
Hover over the graphic below for an interactive look at the functionality of Compass Code Edits.
|Ambulatory Surgical Center (ASC)||Procedure to Procedure (PTP)|
|Add-on Codes||Medically Unlikely Edit (MUE)|
|Diagnosis & Age Conflict||Procedure & Gender Conflict|
|Invalid Procedure for Assistant Surgeon||Bundled Procedures (B Codes)|
|Invalid Procedure for Co-Surgeon||Incidental Procedures (T Codes)|
|Diagnosis & Gender Conflict||Terminated Diagnosis Codes|
|Global Surgery Edit (GSE)||Terminated Procedure Codes|
|Invalid Diagnosis Code|