SLAM Claims Validation
SLAM Claims Validation informs commissioners which claims to accept, which to reject and which to dispute. It supports this with a full audit trail down to the lowest level of detail.
SLAM Claims Validation allows Providers to pick up data that requires attention early enough to make changes prior to the payment process. As a result SLAM Claims Validation helps significantly reduce the number of challenges raised against Providers.
Utilising hundreds of rules and data quality checks SLAM Claims Validation will identify issues such as:
· Coding Errors – potential saving of 3.9% (Source: Audit Commission)
· Claims outside of contracts – potential saving of 4% (estimate based on client activity)
· Invalid or missing data
· Claims to the wrong PCT
· Data inconsistencies
· Episode not pre-approved
· Overlapping episodes
· Excessive length of stay
· Unauthorised or incorrect referrals
Benefits:
· Full analysis of claims within an hour of receiving the SUS files
· Fast dispute resolution
· Ensures PCTs meet governance requirements for the management of expenditure
· Based on the SLAM platform
· A fraction of the cost of alternative solutions
· Ability to justify rejected or disputed claims
· Ready to use within a month
· No technical IT skills required
· Quick and easy to use
Key Features:
· Analysis of provider claims against over 70 rules
· Rules can be amended locally
· New rules can be added at any time
· Full transparency of reasons for disputing or rejecting claims
· Access to all supporting data
· Drill down to individual patient records
· Uses standard SUS files
· Can also be run against submissions directly from providers
· Based on the SLAM platform
· Regular updates in line with national guidance
· Full set of reports in under an hour
· Reconciliation reports to explain how data is processed
· Works for local data as well as for SUS
· Supports local and national tariffs (and agreements]
· Monitors pathway irregularities