Why JHS?

We ensure payments are in accordance with contractual terms and/or CMS Fee Schedules for all product lines.

Our systematic methods will uncover errant claim payments, help identify possible system limitations and process inefficiencies.

Our 'payment issue' feedback should help you decrease future disputes.

We will lead the effort in recovering any funds your organization contractually deserves.

We will work with your organization to find the most effective way to recover these funds.

Managed Care Claims Audit

Health Plans contract with Providers to provide quality healthcare services to their members. They agree to reimburse Providers at contracted rates. Once the payment is applied to the patients' billing, a claim is considered 'closed'.

At JHS, we are committed to ensuring payment accuracy. We will systematically apply contractual terms, language, or CMS guidelines (where applicable) to each claim, identifying any payment issues.

Many healthcare organizations contractually agree to utilize CMS Guidelines and Fee Schedules as their core reimbursement methodology.

JHS has a proven track record of validating these guidelines, pricing claims accordingly, and identifying any payment issues.

see also: Medicare Claims Audit