Verscend drives better healthcare outcomes through data analytics, supporting payers' financial performance and quality improvement initiatives.

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how clinical validation is good for payers, providers, and patients

"From the Trenches" is a new podcast from Verscend exploring the latest trends in healthcare quality and performance analytics, risk adjustment, payment integrity, and payer-provider collaboration. Listen to our latest episode as we examine how clinically validating claims doesn’t just lead to better outcomes for health plans, but also their members and providers.

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asthma and allergy: exposing the “rash” of provider schemes

The nationwide rise of identifiable allergens has resulted in a notable increase in billing and payment of allergy and asthma codes. High reimbursement rates and limited oversight allow some providers to exploit this vulnerability, obtaining payment for services that may not be medically necessary or provided at all. Our on-demand webinar demonstrates how to recognize red flags in asthma and allergy medical record documentation that would warrant a more in-depth medical review.

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the 2019 Star Ratings program:
making the cut

Cut points are the ranges within which a measure’s score needs to fall in order to be assigned a certain star value. As an example, here is....

podcast: how clinical validation is good
for payers, providers, and patients

When a health plan denies a claim, the provider wants to know why it was denied. Sometimes, the answer is that a modifier appears....

coming "off the sidelines"
in value-based care

While collaboration between payers and providers is the most crucial component of delivering better care at lower cost in the United States....

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Payment Accuracy


how to stay in shape for the HEDIS® 2019 marathon


Star Navigator

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).