Veracity™ DataMine is an enterprise data store that is comprised of:
- Institutional 837 claims (including professional claims)
- Institutional 835 remits (including professional remits)
- Payor tables
- Provider NPI tables
- HIPAA reason code table
This data is integrated into the Veracity™ AuditMaster and Veracity™ AppealMaster modules, allowing cases to be created and populated automatically from the DataMine. Cases are also linked directly to all related 837 claim and 835 remittance files, giving the user line-item detail at their fingertips.
A powerful query tool is provided that allows users to search their DataMine to:
- Continous monitoring of audit risk by automated queries using RAC approved issues list or a payor’s audit targets
- Indentify denials as they occur for follow up and appeal if appropriate
- Analyze the source of denials such as registration, coding, case management etc. for greater accountability
- Analyze denials by payor, insurance plan, physician, patient type to identify improvement opportunities
- Automatically assign follow-up or appeal work lists by pre-defined queries
- Export cases to Excel for further data analysis