Compliance

efficientC offers a full suite of tools to ensure compliance throughout the claim cycle

Exceptional editing - custom provider edits prevent non-compliant claims from ever being billed.

Audit trail - database of all claim changes and complete audit trail allowing for well-informed decisions.

Medicare compliance - automated processing to ensure compliance in Medicare shadow billing, MSP zero-pay compliance, RTP processing and more.

Analytics on physician CPT and modifier usage - reduces audit risk and lost revenue.

Robust monitoring, tracking and reporting - organizational accountability across all departments.

Denials by category (medical necessity, coding-related, RAC recoups) - just one click for denial trends and billing compliance issues.

Team standards and training - strict guidelines and regular training courses that detail the fundamental compliance principles, values and framework for action.

Comprehensive Medicare edits (CCI, MUE, LCD/NCD, OCE/MCE) - flexibility to run on any paper.