ClaimWise™: A deeper look at Nokomis’ powerful claim review engine

When a claim is submitted to ClaimWise™, it’s passed through hundreds of custom-built rules, millions of code edit combinations, and scores of reference tables. This process uses intelligent claim selection to identify claims that likely contain inaccuracies, which our team of expert coders, reviewers, and analysts will then further investigate and request records as needed. Because this process is so efficient, we’re equipped to return 100% of concurrent claims to our clients within one business day, but often within minutes or hours. Since ClaimWise™ is fully customizable to our clients’ needs, we can turn rules and edits on or off for a particular client, and we can customize business rules to make claim edits more or less aggressive depending on client requirements.

Since our entire team has worked with providers, health systems, health plans, and more, we worked to ensure that ClaimWise™ was not only accurate and customizable, but as easy to implement as possible. Of course adding any new system will come with a brief learning curve, but our team is dedicated to supporting our clients and their members at every step. We’ll always do the “heavy lifting” wherever we can, from adapting our file layouts to our clients’ format, to directly handling any rare balance-billing issues that may arise (although 99.3% of our recommendations see no appeals). Additionally, we designed ClaimWise™ to work alongside any existing systems already in place for payment integrity–we generally still save our clients on average an additional 9% on top of whatever savings their other systems may be identifying.