Reducing health care costs using claims adjudication software.

An important area for reduction in health care costs is incorrect coding of physician services. Current software systems provide high-volume, consistent claims review with substantial savings for payers. The third generation of such systems offers comprehensive coverage across clinical disciplines, across individual claims, and across an entire history of claims. It is likely that these systems will be useful to both nontraditional payers, such as physician groups and hospital-based networks, and traditional payers seeking to reduce costs and enhance competitiveness.