Our Thoughts on Best Practices

A lab test was performed for a genetic screening of prostate cancer. The plan would have paid $2,233, but after reviewing records, Nokomis denied this because the plan had a policy on when that’s appropriate to use, and the patient did not meet the criteria. We ultimately saved the plan the entire $2,233. Oftentimes, you…

A 60-year-old patient presented to an ER with COVID symptoms. Their health plan would have paid $8,659, but after reviewing records, Nokomis found upcoding and charges for services not rendered. We ultimately saved the plan $7,266.

A 30-year old female presented to a birth center for the delivery of one child. Her health plan would have paid $17,190, but after reviewing records, Nokomis found incorrect codes – they billed for multiple births, and additional services that were not rendered. We ultimately saved the plan the entire $17,190.

A 34-year-old patient presented to a free standing ER for heart palpitations. After reviewing records, Nokomis found incorrect code assignments, codes for services not provided, and inappropriately billing for supplies. We ultimately saved the plan $15,498. We’re not in the business of cherry-picking claims to review or denying care, we’re aiming for an honest and…

A 64-year-old male went to a sleep clinic for a sleep disorder. His plan would have paid $858, but after reviewing records, Nokomis found that none of the codes were supported; there was upcoding and the plan was being billed for services not rendered. We ultimately saved the plan all $858.

A 37-year-old woman was presented at her midwife appointment. Her plan would have paid $2,470, but after reviewing records, Nokomis found upcoding and incorrect code assignments, and ultimately saved the plan all $2,470.

A 31-year-old male underwent abdominal surgery for an ulcerated colon. His plan would have paid $73,409, but after reviewing records, Nokomis found many incorrect code assignments and ultimately saved the plan all $73,409. It’s important to note that this recommendation was not appealed!

A 28-year-old patient presented to their physician with an alcohol dependency issue. Their plan would have paid $424, but after reviewing records, Nokomis found they were being charged for the incorrect level of service, ultimately saving the plan the entire $424.

A 43-year-old woman visited her oral surgeon’s office for a surgical procedure to remove and biopsy a tooth. Her health plan would have paid $2,014, but after reviewing records, Nokomis found that the documentation supported only one claim line, ultimately saving the plan $1,107. Medical record review matters and these claims might seem OK at…