Payment Integrity

With the shift toward value-based payment models, Signature can help assess the risk-adjustment for patients with chronic, serious, or multiple health conditions to predict future healthcare costs. We keep current with latest guidelines for Hierarchical Condition Category coding to safeguard the payment integrity of your program. Through retrospective reviews we will:

• Assign appropriate qualifying HCC code-based specificity of documentation
• Verify each diagnosis listed under an HCC meets the MEAT (Monitor, Evaluated, Assess, Treat) criteria
• Review documentation to ensure it supports HCC codes

Our credentialing services include both verifying the legal qualifications of providers like licensure, and fraud, waste and abuse disqualification as well as verifying the enrollment process to make sure providers complete the steps to join network programs.

Prior to adjudication, we’ll make sure claims match rules.

• Team of both payer and provider subject matters experts creates specialized business rules edits to minimize improper payments
• Perform analysis of claims data to identify trends and issues with potential areas of overpayments
• Proactive research regulatory changes to keep claims edit content current
• On-going monthly maintenance to ensure proactive payment integrity