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Post-Payment Clinical Audits

Identify waste and abuse while protecting provider relationships

Identify losses and recover funds

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.

The latest in Post-Payment Clinical Audits

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Caring for providers during clinical audits

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.

Ways we help

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Technology

Our highly flexible proprietary system provides secure post-claims payment analysis, identifies erroneous claims and overpayments, spots Diagnosis Related Groups (DRGs) and other coding errors, 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 provider 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 Post-Payment Clinical Audits

Trusted partner

We are with you every step of the auditing process—from claims analysis and review and provider communication to final recovery.

Provider sensitivity

Our collaborative approach to conducting clinical audits includes a high level of provider sensitivity to increase engagement and alignment.

Custom analyses

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.

Our Post-Payment Clinical Audits improve the identification and recovery of claims overpaid due to incorrect Diagnosis Related Groups (DRGs) and other issues.

Your Post-Payment 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 Post-Payment Clinical Audits results.