Quality, Accuracy, Compliance Review

Quality, Accuracy, Compliance Review

Value Statement

Reducing fraud, waste, and abuse and minimizing processing time through quality, accuracy, and compliance.

Medical and Application Review

During our case review process, we review Emergency Room reports and consumer injury data to confirm the accuracy of the data submitted by hospitals. We send error messages, purge Protected Health Information (PHI)/Personally Identifiable Information (PII) from cases, and code additional variables such as mechanism of injury to the cases. Our work in case review with the CPSC assists the agency in data collection for analysis of consumer product injuries through their National Electronic Injury Surveillance System (NEISS) and is used by other agencies such as the Center for Disease Control (CDC) in their All Injury Program.

Adaptive Case Management

Our document management services include the intake and validation of medical records; intake, scanning, and uploading of consumer, state, federal, and manufacturer/retailer documents; coding of product and incident data; and redaction of PII from investigative materials released to the public. RELI Group performs documentation validation to support CMS and ensure that documents are submitted in accordance with CMS submission instructions. This process also ensures the integrity of documentation submitted for Improper Payment Measures and payment recovery activities. We assist the CPSC in document management and data collection efforts that are used to determine if consumer products require further investigation. Our redaction services ensure that PII is removed from in-depth investigations prior to public release to protect individuals.