DRG Validation

Diagnosis Related Groups

Reimbursement Returns

DRG Validation is an important tool for controlling healthcare costs. DataMetrix uses a broad spectrum of technical, clinical and practical applications to provide DRG Validation services that deliver returns and improve bottom line savings.

How It Works

  1. Paid claim data is analyzed for of anomalies such as mismatched diagnosis and procedure codes, etc.
  2. Once identified, medical records for coding audit are requested
  3. Facility is provided with a thorough explanation of coding issues and submits any other relevant documentation to DataMetrix
  4. Auditors conduct in-depth examination of all data

It involves in-depth clinical review by our highly experienced and credentialed coding professionals. To identify coding and sequencing errors that impact DRG assignments, we use our proprietary technology to analyze paid claim data in search of anomalies. Once revealed, the audit team requests medical records, lets the provider know which claims are in dispute, and begins its examination of the data provided. Our certified specialists know the most effective way to present data to ensure a timely turnaround and successful outcomes.

Our post-payment DRG assignment review results in savings. Of those claims processed with this service, DataMetrix is highly successful in securing provider sign off.

DRG Validation

Diagnosis Related Groups

Reimbursement Returns

DRG Validation is an important tool for controlling healthcare costs. DataMetrix uses a broad spectrum of technical, clinical and practical applications to provide DRG Validation services that deliver returns and improve bottom line savings.

How It Works

  1. Paid claim data is analyzed for of anomalies such as mismatched diagnosis and procedure codes, etc.
  2. Once identified, medical records for coding audit are requested
  3. Facility is provided with a thorough explanation of coding issues and submits any other relevant documentation to DataMetrix
  4. Auditors conduct in-depth examination of all data

It involves in-depth clinical review by our highly experienced and credentialed coding professionals. To identify coding and sequencing errors that impact DRG assignments, we use our proprietary technology to analyze paid claim data in search of anomalies. Once revealed, the audit team requests medical records, lets the provider know which claims are in dispute, and begins its examination of the data provided. Our certified specialists know the most effective way to present data to ensure a timely turnaround and successful outcomes.

Our post-payment DRG assignment review results in savings. Of those claims processed with this service, DataMetrix is highly successful in securing provider sign off.