Who Should Use This Service
Plans that are paid by DRG (including, a percentage of DRG) whether the providers are contracted or not. Out-patient claims must be paid on an APC methodology. Short StayReview applies to all plan types, for example Medicare Advantage, Medicaid Managed Care and Commercial using DRG in-patient and APC out-patient pricing methodology.
Process for Evaluation of Client’s Claim
HealthMind will conduct a no-charge evaluation of a six month claim extract. We will review the extract to determine that Short Stay occurrence meets minimum standards for implementation of this project. Your company must provide the extract in DataMetrix data formats or otherwise agreed to formats that meet the data element requirements. Prior to acceptance of claims for HealthMind reviews, your company must provide a written statement detailing its policy on prompt payment and related time extensions when record requests are made of the provider.
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