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Healthcare bills for non-contracted services, duplicate charges, incorrect Diagnosis Related Groups (DRGs) and other codes, and more complicated billing practices create significant financial and compliance risks for your organization.
Our Post-Payment Clinical Audits analyze healthcare claims to detect and billing errors, helping to identify excess waste from your overall claims spend and recover overpayments. Using proprietary audit and data mining algorithms combined with expert clinical reviewers, we accurately evaluate the cost and clinical appropriateness of charges 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.
We are with you every step of the auditing process—from claims analysis and review and provider communication to final recovery.
Our collaborative approach to conducting clinical audits includes a high level of provider sensitivity to increase engagement and alignment.
Our Post-Payment Clinical Audits support a variety of services and claims types according to your plan’s specific provider contracts to maximize efficiencies and recoveries.
Recover and restore value to get the revenue you deserve and make healthcare more affordable.