Prevent losses and recover funds
Bills for non-covered services, duplicate charges, wrong codes, and more create significant financial and compliance risks for your health plan.
Our Clinical Audits solution analyzes and reviews healthcare claims to detect and deter billing errors, helping to take out waste from your overall claims spend. Using proprietary audit and data mining algorithms backed by expert clinical reviewers, we accurately evaluate the cost and clinical appropriateness of charges before and after they’re paid, delivering timely turnarounds and a high rate of successful outcomes.
Ways we help
Technology
Our highly flexible proprietary system provides secure pre- and post-claims payment analysis, identifies erroneous claims and overpayments, spots pricing errors, manages recoveries, and delivers custom reports.
Expertise
Our seasoned medical experts and clinical auditors know how to work with your provider networks and unique policies to increase positive outcomes and maintain healthy relationships.
Recovery
Our tools and people take the hassle out of finding billing discrepancies, saving you valuable time and offering greater recovery potential.
What you get with Clinical Audits
Trusted partner
We are with you every step of the auditing process—from claims analysis to clinical review and provider communication to final recovery.
Custom analyses
Our Clinical Audits solution supports a variety of services and claims types according to your plan’s specific provider contracts to maximize efficiencies and recoveries.
Provider sensitivity
Our collaborative approach to conducting clinical audits includes a high level of provider sensitivity to increase engagement and alignment.
Audit findings
Detailed audit findings show opportunities to update flaws in your coding or billing processes and minimize future billing errors.
Discovery’s Clinical Audits solution improves the identification and recovery of overpaid claims and improper bills, leading to greater compliance and financial performance
Your Clinical Audits partner
Recover and restore value to get the revenue you deserve and make healthcare more affordable.
Prevent
Minimize future billing errors with process updates
Correct
Detect and deter overpaid claims and improper bills
Recover
Increase compliance and financial performance
Contact us today for more information on accelerating your payment integrity results
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