Clinical & Coding Logic
Equian goes beyond typical medical bill review, digging deeper into billed charges at the line level to identify errors and patterns of inappropriate billing. We address market gaps in payment integrity for Workers’ Compensation through our Clinical & Coding Logic program.
To ensure Payment Integrity in Workers’ Compensation, our Clinical & Coding Logic solution includes incremental rules and edits that exist above and beyond industry standard edits found in most review platforms. This additional rule logic is based on coding foundations and principles sourced to the American Medical Association’s CPT guidance, Medicare methodology, specialty society guidance, our proprietary database for implant/supply costs, industry benchmarks, and national payers’ payment schedules.