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Prepay Itemized Bill Review

Over $9,000 Average Savings Per Claim

In 2014, CERiS partnered with a large national payor to perform prepay itemized bill review.  At the time, CERiS was one of several vendors providing this service. Through consistent results and a successful partnership, by 2020 CERiS became the exclusive national prepay vendor. The head of vendor management calls CERiS her “Gold Standard Partner” due to our responsiveness, results and transparency. She stated, “CERiS is a true extension of our Payment Integrity department and a true partner in how they spend the time to learn our business and build relationships with each individual health plan."

Going forward, CERiS’ challenge will be to continue to be a supportive partner through the ever-changing healthcare landscape. Our partner is looking to expand their program with CERiS into other review offerings including Facility Repricing, Professional Claim Review, Implant Review, and prepay DRG Validation, where CERiS can perform dual reviews.

Ultimately the results and partnership speak for themselves. There has been a consistent collaboration and mutual agreement on annual objectives that drive savings results. Year over year, CERiS has continued to surpass the annual savings goal by over 20%.