With a national footprint, we maintain a reputation of trust and professionalism in all of our services.ĬorVel Corporation and all associated companies and subsidiaries (“CorVel”) have created this Privacy Policy in compliance with applicable laws and in order to demonstrate our firm commitment to privacy. Medical CommunityĪt CERiS, our decades of experience with the medical community provide the foundation needed to work with hospitals and healthcare providers. Our comprehensive reviews and detailed insights into facility claims make us a vital partner to large commercial insurance providers and employers who are seeking payment integrity and identifying fraud, waste and abuse (FWA). Working closely with our community, we continue to build an industry standard to clarify billing interpretations and formulate ethical payment practices. When reviewing facility claims, we often work with our partners and entities such as the Centers for Medicare/Medicaid Services (CMS). We are proud to have a community of relationships that spans Medicare/Medicaid entities, commercial health networks and insurers, third party administrators, managed care organizations and state agencies. National Uniform Billing Committee (NUBC) Publications.Information regarding generally accepted claims/billing/payment practices.Provider Reimbursement Review Board (PRRB) Publications/Opinions.Medicare Administrative Contractor (MAC) Publications.
Office of Inspector General (OIG) Publications.10) CMS Transmittals Medical Learning Network (MLN) Matters Medical Learning Network (MLN) Matters – Special Editions 100-08) One-Time Special Notification (Pub. 100-02) National Coverage Determinations (Pub. CMS Publications, including: Benefit Policy Basic Coverage Rules (Pub.Some of the resources utilized by CERiS include, but not limited to: Escalation of the appeal is not solely based upon the request of the provider, but is determined based upon the Appeal Representative’s research of the original determination, as well as, their review of the correspondence and documentation submitted by the provider and/or the provider’s representative.ĬERiS utilizes many national billing guidelines and standards during its review of claims for payment. Once a determination has been made on the file, the Appeals Representative will generate a response with the corresponding documentation to be faxed to the appeal contact. If the Appeal Representative determines that the documentation requires the additional review of a medical review professional, the file will be resubmitted to our Medical Review Department for determination. CERiS provides an appeal process for all claims on which their review has been utilized. Once an appeal is received, either by post mail or fax, it is logged and submitted to an Appeals Representative for review. The Appeal Representative will review all of the information and documentation submitted with the appeal.
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