FAQs
Who is Calypso and what does Calypso do?
How does Calypso bill for services?
What types of overpayments do you look for?
What claims processing platforms do you have experience in?
Do you have expertise auditing FEP?
Are your services available to self insured or ASO/ASC clients?
Do you offer Subrogation recovery management services?
What experience does Calypso have with claims system conversions?
I am concerned about the relationship with my provider network. How do you work with the providers?
Why is post payment recovery necessary if I am doing effective pre payment audits?
Who is Calypso and what does Calypso do?
Calypso Healthcare Solutions is a professional services firm backed by powerful technology to provide claims payment accuracy services to the healthcare payers.
How does Calypso bill for services?
Calypso charges a contingency fee based on our performance in discovering and recovering overpayments.
Calypso focuses on discovering, recovering and preventing claim overpayments. Our process combines experienced auditors and recovery specialists with powerful and robust technology to identify and aggressively recover overpayments. We partner with our clients to prevent future overpayments through root cause analysis and quality improvement. Clients can realize significant savings that directly impact their bottom line.
Calypso focuses services towards the healthcare payer industry, including Commercial, Government and Self-insured plans.
As a business associate of covered entities (health insurers), Calypso complies with all HIPAA Privacy and Security regulations.
What types of overpayments does Calypso you look for?
Calypso looks for overpayments in the following areas:
- Processing errors due to eligibility, incorrect coding, contracts/pricing and benefit structures
- Duplicates
- Configuration errors due to non-standard member benefits, non-standard provider contracts and editing requirements
What claims processing platforms do you have experience in?
Calypso has experience in many claims platforms including Facets (TriZetto), QBLUE/QMAX, NASCO, GBAS, BCC, HSII, CSC, and AMSYS.
Do you have expertise auditing FEP?
Yes, Calypso does have expertise auditing Federal Employee Plan (FEP) claims.
Fraud is an intentional act of deception, misrepresentation or concealment of material fact or information. External fraud means that such an act is committed by a third-party (member, provider, agent, broker or employer group) in order to gain something of value from the Company.
Examples of fraud include:
- Billing for services not provided
- Intentionally using an incorrect or inappropriate provider number to be paid
- Signing blank records or certification forms that are used by another entity to obtain payment
- Falsifying information on applications, medical records, billing statements and/or cost reports
- Misrepresenting non-covered services as medically necessary, by using inappropriate procedure or diagnosis codes
- Providing false employer group and/or group membership information
Abuse is an action against the Company that is inconsistent with acceptable business and/or medical practices that results in an unfair gain to the claimant.
Examples of abuse include:
- Using procedure or revenue codes that describe more extensive services than those actually performed
- Billing for services grossly in excess of those needed by patients
- Incorrectly apportioning costs on cost reports
The difference between fraud and abuse is in the area of intent.
Are your services available to self insured or ASO/ASC clients?
Yes, we do offer our services to self-insured business and Third-Party Administrators.
Do you offer Subrogation recovery management services?
In states that allow subrogation, Calypso does offer these services.
What experience does Calypso have with claims system conversions?
Calypso has extensive experience auditing claims and providing claims payment accuracy services during claims system conversions.
I am concerned about the relationship with my provider network. How do you work with the providers?
By aligning our recovery goals with our customer’s priorities and requirements, Calypso’s recovery specialists maintain strong relationships with your provider networks while maximizing recovery opportunities.
Why is post payment recovery necessary if I am doing effective pre payment audits?
Pre payment software attempts to correct mistakes before they happen, however competing priorities, like prompt payment requirements, create conflict in accurately paying claims. Calypso’s solutions compliment pre payment programs by discovering the overpayments that can occur from quality related issues or from claims that are paid where information becomes available post payment i.e. Coordination of Benefits, Subrogation, Provider Billing Errors.
To learn more about Calypso’s services and how they can help you, please call 1-888-448-5406 or email info@calypsohealthcare.com.