Payer Desk

At Cosmos Medical Care Solutions, we understand that payers, TPAs, and health plans need more than just coding support—they need trusted partners who ensure care accuracy, reduce unnecessary costs, and strengthen regulatory compliance.

Our Payer Desk delivers focused, high-impact services that combine clinical insight with operational precision:

Prospective Review

We evaluate medical records and documentation before services are rendered, helping you:

Validate medical necessity
Confirm correct coding
Support preauthorization workflows
Prevent avoidable costs

This proactive approach reduces denial risk and improves decision-making.

Concurrent Review

We monitor ongoing patient care to ensure:

Continued medical necessity
Compliance with treatment protocols
Cost-effectiveness of services
Timely interventions when needed

Our concurrent reviews offer better care visibility and resource control.

Retrospective Review

We analyze medical records after care is delivered to:

Confirm coding accuracy
Identify unnecessary or unbilled services
Support appeals and policy adjustments
Strengthen provider accountability

Retrospective reviews help you make data-driven decisions for future care guidelines.

Coding Validation & Risk Adjustment Support

We work with payers to validate provider coding and strengthen documentation by offering:

HCC and RAF score validation for risk-based plans
ICD-10 and CPT coding audits aligned with CMS/NCCI rules
Retrospective coding reviews to support appeals and policy updates
RADV audit preparation and compliance support

Our insights help improve data integrity, reduce overpayments, and prepare for CMS reviews.