Cost Avoidance and Audit Solution
Our Audit Solutions are designed to help healthcare payers reduce and ultimately prevent inappropriate or incorrect payments. Through our Data Mining and RAC-like business rule engines, we identify and track accuracy and necessity of payments. These are designed to pinpoint coding errors and reduce billing.
We process live and historical claim data through our detection engine in order to identify services that do not comply with billing rules. Suspect claims that require additional review are also identified and managed through an exception handling process.