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.
Clinical audits play a critical role in ensuring health plans’ financial health. Recognizing that these audits have the potential to cause provider abrasion, communication and education should be part of a health plan’s clinical audit program.
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.
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.
Our tools and people take the hassle out of finding billing discrepancies, saving you valuable time and offering greater recovery potential.
We are with you every step of the auditing process—from claims analysis to clinical review and provider communication to final recovery.
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.
Our collaborative approach to conducting clinical audits includes a high level of provider sensitivity to increase engagement and alignment.
Detailed audit findings show opportunities to update flaws in your coding or billing processes and minimize future billing errors.
Minimize future billing errors with process updates
Detect and deter overpaid claims and improper bills
Increase compliance and financial performance
