Our healthcare claims audit software greatly enhances the productivity and effectiveness of. Audit iq is a health care claims auditing software designed to efficiently and effectively identify errant payments. Datamethod inc claim audit software and cost containment. Riskonnects audit software tracks and monitors every step of the process for safety, claims, or field audits to ensure compliance, gauge. Similar to medical claims audits, plan documentation is received, claims data is analyzed and samples are selected. Auditing software and services medical auditing aapc. Use aapc medical auditing software and services for accuracy, compliance and timely delivery. 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. For physician practice audits, 10 claims are usually enough. To determine outliers before large payers find them in their claims software and request an internal audit be done. 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. Clients use cat to facilitate pre and postpayment claims audits. Hms advances the healthcare system with innovative solutions that help organizations reduce costs and improve health outcomes. Since 1999 frg has been a leader in medical claims audit. 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. Jgi offers exceptional medical claims audits customized to each clients unique needs. A statistical sample is also an option, especially if your audit department has sophisticated software, he says.
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. 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. A workflow tool for audit of healthcare transactions. Get allinone solution designed by medical auditing experts. Claims audit tool healthcare information management, inc. Experience total oversight of your entire audit program. Founded in a basement in 1979, epic develops software to help people get well, help people stay well, and help future generations be healthier. In february 2015 emblemhealth upgraded its claimsxten software to the. Our medical claims audits, pharmacy audits, and dependent eligibility audits help self insured plan sponsors reduce their healthcare costs. Profee and facility medical auditing software cloudbased access. 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 manager is designed by auditors, for auditors. Experience the only intelligent, allinone medical auditing software solution.