Claims and data validation is performed to reconcile incomplete, incorrect or missing data from files prior to submission. Advantmed meets CMS requirements with a thorough review of claims data.
Advantmed’s Claims Validation services confirm the HCCs that are documented in a claim (administrative data) are supported by clinical documentation. Our solution considers claims data provided by the client and maps all the diagnostic codes to HCCs. Advantmed will review and blind code a chart and match the clinical data back to the claims data. HCCs that are not supported are reported back to the client as unconfirmed.