All reviews are handled before payment, within one business day, and plans only pay a percentage of the savings that we identify.
Since 2013, our unique combination of ClaimWise™ technology and experienced reviewers finds claim inaccuracies that others miss, regardless of dollar amount. We review all claims in one business day, before payment.
We’ve worked in health plans, so we understand the process of adding a new vendor–we know it takes time so we’re here to make implementation as easy as possible.
We aim to amplify the work that your team already does; Nokomis can work alongside any existing claims review process. The work we do is vital to finding inaccurate claims that might have just been paid otherwise.
A 56-year-old male underwent cardiac valve replacement surgery. The surgeon charged $210,000 for several codes; reimbursement was pending at 70% of charges. We obtained records and denied 3 of the 5 codes for not being supported by the documentation, resulting in savings of over $96,000.
Out of Network Claims
We offer many solutions for reducing out-of-network claim costs. From claim negotiation to travel networks to reference-based repricing, we strive to obtain the deepest secured discounts on your out of network claims.
An out-of-network surgeon charged $49,935 for treatment of a lower leg fracture. Nokomis staff negotiated a case rate of $3,957 on the claim, with provider signoff and agreement to not balance bill the member, resulting in savings of $45,979.
Maintaining data integrity for processing claims can be difficult. We provide enrollment and provider data audit services which increase accuracy in enrollment, benefit set up, billing and provider data – making you more efficient and competitive for your clients. We are well equipped and take pride in our ability to work with large sets of data.
Nokomis reviewed enrollment records for a client and found an error rate of 18%, primarily due to poor data entry and lack of quality assurance practices. We worked with the client to enhance their employee training program and to establish a robust QA function, which reduced the error rate to less than 1%.
As industry experts, we offer consulting services that can be adapted to the needs of each individual client. We know billing, coding, reimbursement, and everything in between. We offer coding assistance from our certified coders as well as on-site training regarding coding, billing, and reimbursement. From hospitals and clinics to health plans, third-party administrators, and law firms, we have experience working with more than 120 organizations.
Nokomis staff developed dynamic reimbursement models for a medical device manufacturer, which enabled the firm to demonstrate to hospital CFOs the financial savings resulting from the use of their products.