charge validation
            analysis

Workers' Compensation

FAIRPAY Solutions' sophisticated, multi-variant analyses and patent-pending technology leverage the power of industry-leading data to consistently deliver highly defensible, jurisdiction-specific savings. Our powerful data-driven methodologies are fueled by authoritative data compiled from more than 20 public and proprietary sources.

FAIRPAY's proprietary algorithms and methodologies deliver accurate payment recommendations resulting in fewer reconsiderations and less dollars given back. Additionally, our analyses incorporate state laws, statutes and case law ensuring our reviews comply with jurisdictional requirements.

FAIRPAY's methodologies include Charge Validation Analysis (CVA) and Market Value Pricing (MVP). These proprietary processes identify erronious or inappropriate provider charges at the line item level and help payers find a fair, reasonable price for healthcare.

CVA uses automated evaluation technology to identify inappropriate charges through an intensive review for line item and coding accuracy. If necessary, CVA also compares charges against itemization and medical notes. CVA reduces invalid and inappropriate charges resulting from:
  • Up-coding
  • Billing errors in detailed line items
  • Unbundled and duplicate charges
  • Charges for items and services that were not provided
  • Undocumented or unrelated charges
  • Treatment for injuries or illnesses caused by the facility or provider
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