Medical Claims Review

Medical Claims Review focuses primarily on pre-existing condition determinations, medical necessity reviews, multiple surgery claims, audit potential, UCR and fee information (including up coding of fees and unbundling of charges), and appeals review. CLINIX physician reviewers contact prescribing physicians when the need for services are not clearly identified. Specialty-to-specialty reviews are also available.

The CLINIX Medical Claim Review focuses on...

• pre-existing determinations
• medical necessity
• multiple surgery claims
• specialty reviews
• audit potential
• UCR and fee information
• up-coding and unbundling of charges
• appeals review

CLINIX has distinguished itself from other similar programs in our commitment to prompt courteous service, cost-effective fees, and access to reviewing physicians.