Federal Healthcare Claims Review & Auditing

Concept Plus demonstrates a technical, functional and operational expertise within all aspects of healthcare audit and claims processing.

Repeatable processes provide efficiency, consistency, and transparency.

Federal healthcare relies on its partners to help promote accuracy of provider payments and eliminate fraud, waste and abuse of duplicate and inaccurate claims.

Concept Plus’ specialized procedures identify claim processing errors, overpayments, documentation shortages, compliance with government policy and directives, along with other claim concerns. Our reports provide an independent, impartial review of our determinations and findings. Through our document management system (DMS) application we import, track, and manage claims data allowing for full traceability and history.

Concept Plus offers technical, functional and operational expertise to support all government healthcare agencies.  We have provided over a decade of audit and claims management assistance to the Defense Health Agency (DHA) Improper Payment Evaluation Branch as the current  TRICARE Claims Review Services contractor (TCRS) evaluating the accuracy of claims payment and payment record coding.

Concept Plus proudly supports the Veterans Health Administration, Defense Health Agency, and TRICARE program.

Concept Plus HIT Services

  • Medical
  • Dental
  • Pharmacy
  • US and Overseas
  • TRICARE and VA

Expertise Includes

  • Expert use of claims software and tools (3M GPS, 3M CGS, McKesson Claimcheck, DEERS, TED)
  • Integration of CMMI and ISO industry standards
  • Quality performance rating greater than 99%
  • Specialized focus studies and medical reviews
  • Concept Plus Claims Document Management System