Internal/External Medical Review
C2C has extensive knowledge and understanding of the internal/external medical review process. Our staff of physicians, nurses and other healthcare professionals have years of clinical experience and are proficient in applying applicable statutes, laws, regulations, policies and guidelines to the facts of each case. Our workforce knows how to manage workload efficiently and effectively, which has been demonstrated by our consistent achievement of 99.1% timeliness and 98.5% quality in decision-making. C2C applies its URAC Policies and Procedures and ISO 9001:2015 certified processes to applicable lines of work and is adaptive and flexible to meet your immediate needs, including those unexpected challenges that always arise.
C2C is URAC accredited as an Independent Review Organization (IRO) for Comprehensive Review (Internal and External). We are very experienced in conducting peer and medical reviews with exceptional timeliness and quality. We maintain an extensive healthcare panel of over 2,700 health care professionals which includes the broadest range of physician specialties and subspecialties and many other types of healthcare professionals.
C2C possesses the relevant skills and medical experience required to conduct independent medical reviews on every conceivable medical service. With our extensive experience in reviewing over 6.6 million claim-level medical records over the last 16 years, we have reviewed every type of clinical or facility-based case. We offer extensive experience in conducting peer reviews and determining medical necessity for services rendered.
Document Conversion Services
If huge volumes of paper files have you cluttered or if paying for secured record storage, let us change this burden into easily viewable and searchable electronic records. Over the past decade of service as a government contractor, C2C’s document scanning and conversion services has converted billions of scanned pages into thousands of digitally viewable PDF records on time and to rigorous quality standards.
C2C is equipped with industry standard high-speed, high-volume scanners to achieve greater data integrity for OCR, IDR, validation and other functions, as we capture every bit of information. Our scanners have double feed detection systems to further instill confidence that every record is scanned.
C2C’s imaging and indexing process is highly automated and images are safeguarded using our Authority to Operate (ATO)-approved security architecture. We maintain an agile environment that enables us to tailor processes to meet customers’ specific needs, including automating manual tasks and analyzing overall processes for greater efficiencies.
C2C has experience performing intake services that result in large volumes of documents that are received daily in various formats and through various methods. These include physical or electronic documents from various resources, such as by courier, mail, fax, FTP, portal, e-mail, CD/DVD, USB drives, etc. These documents are managed, prepared, electronically indexed, and stored with necessary information.
Our demanding quality controls allow the converted image to be certified as the official record, replacing the original physical copies that can be securely destroyed if permitted. We ensure safe delivery of electronic records to your facility using a secured electronic transmission portal, providing immediate access to records.
Coding Review and Oversight Services
Our comprehensive claims review approach uses highly competent and experienced review analysts supplemented by expert physicians, attorneys and Certified Professional Coders (CPCs). Our team of professionals can verify compliance with the claims against the medical documentation and validate adherence with government statutes, laws, and regulations. Areas where we can help include:
International Classification of Diseases (ICD) Code Verification
Medical Record Documentation Review
Traditional Customary Review
Appeals Resolution Services
With nearly two decades of experience, C2C manages medical claims on appeal at the second level of Medicare appeal timely, accurately and with the highest degree of security. We manage claims with the utmost integrity using today’s industry standards. Our strengths are applied to every project with the highest sense of productivity, flexibility and with a customer-centric approach in mind to meet each client’s individual needs.
C2C understands the critical importance of information security and is committed to meeting and exceeding each of our client’s security requirements. These controls focus on the use of information protection policies, guidelines and standards carried out through technical and operational procedures, and meet and exceed the National Institute of Standards and Technology (NIST) and the Health Insurance Portability and Accountability Act (HIPAA) requirements.
Our security plan is comprehensive, proven and includes the following major components: Compliant IT Infrastructure; ISO 9001:2015 certified Workforce Policies and Procedures; and a well-defined Business Continuity Plan. C2C’s security controls are rigorously enforced. We take seriously our responsibility to protect the valuable and confidential information needed to execute our client’s requirements.
Benefits and Results: