Healthcare Plans Service Detail

Health Plans contract with Providers to provide quality healthcare services to their members. A fundamental issue on the side of payers is the actual funding for these services through the claims payment process. System limitations, complex contractual terms and language, or CMS guidelines complicate the payment process and potentially stress this relationship.

Our audit service will validate these payments and support your organization in the recovery of any identified overpaid dollars due you.

• Our experts will review your 'closed' claims (considered by your organization as paid correctly and not being pursued internally)
• We will ensure payments are in accordance with contractual terms and language and/or CMS guidelines and fee schedules for all product lines.
• Our programs will uncover errant claims and we will validate that these potential recoveries are not being pursued by your organization.
• Upon completion of each provider audit review, we will present our findings.
• If agreed upon, we will lead the effort in recovering funds your organization contractually deserves.

You'll benefit from…

• Proven track record of identifying and recovering payment errors
• Extensive knowledge of CMS guidelines and its fee schedules that allow us to validate Medicare/Medicaid payment technology.
• Experience in applying and validating Managed Care contract rates, terms, and all footnote language to ensure correct claims payment.
• Perfect mix of software applications will validate your organization's claims' payment process.