Use Cases

• Appeal a claim: When a claim is denied due to medical necessity, an analyst, nurse, and/or physician pulls in the documentation directly via Smart on FHIR and searches (optionally using one of Apello’s pre-defined smart searches, if applicable) to immediately find decision data. The user then annotates, crafts, and sends a compelling appeal to the denying entity based on the patient’s progression and interventions. This process is completed in a fraction of the time previously needed.
• Validate a DRG: Apello is designed to vastly reduce the time to determine the appropriateness of the billed DRG pre- and/or post-pay. Coders, nurses, and physicians search for documents supporting the diagnosis sequencing if the DRG assigned is consistent with the documentation and treatment during the hospitalization.
• Request Authorization or Release of Information: Apello provides a channel for efficient storage and exchange of documentation for analysts, nurses, and physicians throughout a patient’s stay and billing cycle. Specifically, before a service is rendered, the authorization can be saved as a document in Apello; after the service is rendered and billed, supporting documentation can be delivered directly to the health plan. If the patient remains in the hospital and requires an additional authorization, the provider can easily submit medical records (or plans with CAVO® users may directly obtain them).

Supported Devices

• Desktop

Version Details

Compatible with Cerner Powerchart