Many tools and techniques are deployed (data mining, claim editing, advanced training, fraud & abuse, and proprietary algorithms) to turn data information into meaningful and measurable values to help payers reduce cost, mitigate future risk & exposure, and improve end to end payment integrity solutions.
AuditSolutions360 technology and data mining platform manages and tailors a custom-fit payment accuracy and cost-containment program for our clients – health plans offering Commercial, Medicare (Advantage and Fee for Service) and Medicaid plans, for both fully and self-insured plans and TPA’S.
Our comprehensive approach helps to identify and recover improper claims payments associated with adjudication errors, billing errors, or contract language but prevents leakage and reoccurrence of these errors in the future.
