Medical Claim Audit


Each hospital and each hospital’s contracts are unique. While claim audit is a valuable diagnostic tool that is used to review your contracts and processes, it may not always result in recovered revenue.

Denials and underpayments are two critical areas where revenue is lost for many hospitals. For many smaller hospitals, the cost of technology and staffing required to consistently monitor revenue integrity outweighs the potential revenue gains.

Complex contract language often results in payer system loading and interpretation errors, as well as difficulty by hospital staff to quickly identify errors in the payments received. Our process and technology allows us to audit these complex contracts to ensure you are paid based on the agreed terms of the contracts.

During the audit, all findings relating to your portfolio of payers’ practical business conduct and internal issues at the hospital level are reported to you.

In addition, we review certain aspects of your processes such as:

• System Code Mapping
• Code Application
• Late Charges
• “Lost” or Missing Codes/Charges

Our processes and technology allows us to audit these complex contracts to ensure you are paid based on the agreed terms of the contracts.