CERiS Health

The decision makers in CERiS Health are Edward Phillips, Ivan Diller, James Contos, etc. Click to Find CERiS Health decision makers emails.

CERiS Health specializes in providing comprehensive solutions for healthcare payers to ensure accurate medical claim payments. Our services include prepayment and post-payment reviews, fraud detection, data mining, clinical review, and payment integrity consulting. We focus on reducing waste and abuse in the healthcare system by leveraging advanced technology and analytics.

CERiS Health employs sophisticated data mining techniques and predictive analytics to identify patterns indicative of fraud and abuse in healthcare billing. Our team conducts thorough clinical reviews and audits, ensuring that claims are valid and comply with regulatory standards. By implementing prepay reviews and ongoing monitoring, we help healthcare payers minimize financial losses and enhance compliance.

CERiS Health primarily serves healthcare payers, including insurance companies, managed care organizations, and self-funded employers. Our solutions are tailored to meet the unique challenges faced by these entities in managing claims, ensuring compliance, and optimizing payment integrity across various healthcare services.

Yes, CERiS Health offers specialized services in Diagnosis-Related Group (DRG) validation and facility chargemaster profiling. Our experts analyze clinical data and billing practices to ensure that DRG assignments are accurate and reflect the services provided. This helps healthcare payers avoid overpayments and ensures that facilities are billing appropriately based on their chargemaster.

Predictive claim selection is a key component of CERiS Health's approach to payment integrity. By utilizing advanced algorithms and historical data analysis, we can identify claims that are at a higher risk for errors or fraud before they are paid. This proactive strategy allows healthcare payers to focus their resources on claims that require further scrutiny, ultimately improving the accuracy of payments and reducing unnecessary costs.

CERiS Health conducts thorough reviews of provider contracts to ensure compliance with agreed-upon terms and conditions. Our team analyzes billing patterns and reimbursement rates to identify discrepancies and ensure that providers are compensated fairly and reasonably. By maintaining compliance with provider contracts, healthcare payers can foster better relationships with providers and enhance overall payment integrity.