Claims medical review can be an optimizing fiscal tool. A leading California HMO experienced multimillion dollar annual savings in just one region of 100,000 enrollment. This was an additional savings above the results of routine claims review. By profiling your beneficiary population and developing productive screening criteria, your savings can be optimized with costs minimized. Claims medical review is also a powerful management tool. Major process improvements can be made in many organizational activities, including contracting, interdepartmental communications and network development.

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