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Clinical Validation Services

Clinical Validation is a professional service that uses both clinical and coding expertise to identify medical cost savings due to inappropriate charges or incorrect coding on medical bills. Clinical Validation reviews focus on assuring that the medical record supports all codes and service levels billed. In other words, the review certifies that coding meets all appropriate coding rules and all services are related to the injury.

Coventry Workers’ Comp Services uses automated logic and proprietary criteria to identify bills likely to contain the types of questionable charges that can be addressed by Clinical Validation.  Clinical Validation is offered at no financial risk to our clients and is delivered in a high quality (low error rate), acceptable turn-around environment and leverages our advanced adjuster desktop tools to inform clients as to which bills have been identified as eligible for the Clinical Validation review.