NADENT-Health Data Services carefully reviews medical billings to determine questions of appropriateness of care, medical necessity as well as the propriety of medical charges in terms of Reasonable & Customary Charges or the applicable state fee schedules.
All claim information is retained in our computer for three years to check for duplicate services and claimant/provider history, which in many cases will affect reimbursement amount.
If the insurance carrier does not have all the pertinent information to process a claim, NADENT-HDS will request the information. A delay notice will be sent to the insurance company and to the provider.
NADENT-HDS' in-house turnaround time is five to 10 business days.
The monthly invoice summarizes charges, allowances, savings and NADENT-HDS cost for each claim reviewed. This enables clients to allocate the NADENT-HDS fees to each individual case file, while providing an easy-to-understand measure of NADENT-HDS cost-effectiveness.
Complex and time-consuming claims, which require additional charges, will be clearly identified in NADENT-HDS statistic reports.
NADENT-HDS has a panel of board certified physicians in all specialties to perform medical reviews and review particularly complex claims and to advise on questions of causal relationship, medical necessity and over-utilization.
NADENT-HDS will answer any questions and re-evaluate the denial of any claim and return the response to the carrier so that it can then be forwarded to the provider.
NADENT-HDS will defend its decision in medical arbitration or similar hearing.For more information call us at 800-632-3444 or Email us at: mail@nadent.com