Insurance Claim Audit Tool for a Well-Organized Work-Flow:
Just as the work-flow conditions of billing companies are demanding and taxing, the working conditions of payers are no different. They also go through the same grind, auditing and processing claims like their billing counterparts that filed them.
Automation tools are a boon for every workplace with exhausting working conditions. Claim Audit Tool has been designed to ease and enrich the working conditions of claim audit departments of organizations processing healthcare claims.
CAT adds efficiency to claims audit workflow and reporting. The tool has a user friendly front and powerful relational database back end. It streamlines the process of pre and post payment claims audits.
The functionality features of CAT include:
1Rapid data searching, sorting and filtering
2Audit standardization
3Auditors access claims data through user-friendly, menu driven front end
4Claims audited online, reducing reliance on manual processes and paperwork
5Ability to correct over/underpayment errors before checks are issued
6Real-time reporting
7Powerful Audit Filters for Focused/Random Audits
8Auto-Identifies and Routes Errors to Auditors
9Robust Real-Time Reporting
10Automated Correction of Erred Claims
11Customizable Audit Flags
12Tracking/Reporting of Audit Results and Savings
13Easily Customized for any Claims System
14Automated Import of Data Extracts into Application
15User Friendly and Intuitive
16Quick Implementation
17Low Maintenance
18Flexible and Scalable SQL Server Database
19Dedicated and Responsive Product Support
20Benefits
21Improves Payment and Processing Accuracy
22Increases Overpayment Identification and Savings
23Reduces Rework
24Enhances Provider Relations
Insurance claim audit units run series of appraisals to verify the legitimacy of claims and validate disbursements of pay-outs. CAT is built to increase productivity and investigate any inconsistencies in the submitted claims, saving insurance companies millions of dollars annually.
The tool can be customized for any claims system. The implementation is quick and simple, with low maintenance.
The other capability of the tool includes identifying inaccurate claims, with flawed patient information, insurance information and provider information.
It has a virtual examiner to determine CPT codes according to NCCI edits and other industry standard edits. The tool has an inbuilt robotic automation application named ‘Sinkey’, it analysis payer specific claims with the amount billed, amount owed, contractual adjustments, and patient responsibilities.
If an overall turnover needs to be determined, the user can setup a time frame for the data to be displayed. It also has a denial management program, which displays combined data of number/amount of denied claims.
