Welcome DRG Claims Management to the Alliance

SERVICES PROVIDED TO THE MANAGED CARE INDUSTRY:

Payment Integrity Audits

DRG Claims Management (DCM) has been offering cost containment solutions to health plans across the United States since 2013. Services include post-payment model focused on addressing inaccurate coding and clinical errors retrospectively, maintaining good relationships with providers, and ensuring a smooth refund request process. DCM's prepayment model is preferred by health plans to prevent overpayments, reduce turnaround time, increase provider response, and ensure the audit of out-of-network claims.

Why DRG Claims Management?

DCM differentiates from their competitors with customizable solutions and customer service.​​ They offer their clients white glove services, with the following metrics:

• $20 PMPM Savings: Strategic impact on cost reduction.

• 40% Audit Hit Rate: Nearly one-third of all records audited lead to actionable insights.

• 96% Medical Records Acquisition: Effectively obtaining the necessary documentation.

• 95% Accuracy Rate: Precision underlines every audit decision they make.

Products/Services:

DCM audits:

• Hospital Claim Audits (MS/APR-DRGs & APCs)

• Readmissions

• Short-stay/OBS

• Cost outlier & Itemized Bill Audits

• SNF reviews (RUG/PDPM)

• Surgical implants
  

Learn more about DRG Claims Management:

> drgclaims.com