Our standard practice at POMCO is to review and price all facility (inpatient and outpatient) claims submitted to the Plan.

Our review process has been designed by a team of experts of physicians, registered health information technicians, certified coding specialists and registered professional nurses.

All client claims are coordinated with Utilization and Medical Review Services and monitored for appropriateness and coding to validate their necessity in medical protocol. Accredited specialists will perform expanded inpatient claims reviews including, but not limited to, the review of hospital and physician medical records, regrouping and case pricing of services, and the coordination of on-site medical audits.

And for additional review accuracy, all claims are processed through our automated, state-of-the-art Trizetto/RIMS claims review system.

POMCO's inpatient hospital claims adjudication review initiatives combined with our negotiated network discounts can save you as much as 51 percent of facility charges.