Medical claims audit software

Datamethod inc claim audit software and cost containment. With highly flexible audit scope and pricing methodologies, we ensure that every employer group has an opportunity to take advantage of our experience and expertise. Use aapc medical auditing software and services for accuracy, compliance and timely delivery. For physician practice audits, 10 claims are usually enough. Clients use cat to facilitate pre and postpayment claims audits. Depending on the audit firm, audit approach, and technology used, prescription drug claims audits can uncover a wide variety of claims adjudication issues andor weaknesses in areas such as exclusions or limitations, prior. Audit iq is a health care claims auditing software designed to efficiently and effectively identify errant payments. Experience total oversight of your entire audit program. Auditing software and services medical auditing aapc. In either case, include a mix of payers in the sample, with more emphasis on medicare and medicaid, as the federal government is the payer shining the strongest light on fraud. Profee and facility medical auditing software cloudbased access. Claims audit tool healthcare information management, inc. Hms advances the healthcare system with innovative solutions that help organizations reduce costs and improve health outcomes.

A clinicallybased claims payment software solution for payers that want to create and deploy flexible, automated rules to help improve payment accuracy, reduce appeals, and realize medical and administrative savings. Jgi offers exceptional medical claims audits customized to each clients unique needs. Since 1999 frg has been a leader in medical claims audit. Use aapc medical auditing software and services for accuracy, compliance and.

For each medical claims audit, or in each recurring audit cycle, we apply state of the art technology through multiple in house statistical analysis software sas servers to stratify volume by place of service, by facility, by type of claim and by other natural common dimensions as dictated by the data itself. Our healthcare claims audit software greatly enhances the productivity and effectiveness of. The claims audit tool cat is designed to be used in the claims audit departments of organizations paying healthcare claims. Capture and create clean, professional reports on every. Get allinone solution designed by medical auditing experts. Audit manager is designed by auditors, for auditors. Similar to medical claims audits, plan documentation is received, claims data is analyzed and samples are selected. Claimsauditor is the nations newest, fastest and most flexible cloudbased technology that allows compliance teams and other healthcare professionals to find coding, compliance and financial risks and opportunities hidden in their provider claims and other detail data. In february 2015 emblemhealth upgraded its claimsxten software to the. Experience the only intelligent, allinone medical auditing software solution. A statistical sample is also an option, especially if your audit department has sophisticated software, he says. To determine outliers before large payers find them in their claims software and request an internal audit be done.