A workflow tool for audit of healthcare claims.
20 years and counting!
2018 Prepay Dollars Audited
2018 Claims Audited
2018 Total Payment Errors Identified
2018 Claim Payments Audited
53% increased auditor productivity
Reduce your audit cost by 1/3
Reduce payment errors by 25%
Increase recoveries by 10x per year
Learn more about what you get
Save More Administrative and Claim Dollars.
Integrated audit, cost containment and recovery workflows may reduce your claim overpayments by up to 10x per year. Using our advanced rules engine on your claims, call, audit, and configuration files provides an easy way for your audit staff to stop claim payment errors before they happen. That’s real money.
In addition, automated workflows and customizable process steps built into ClaimAuditor will help reduce the unnecessary and manual workload on your claim audit team and payment integrity teams by up to 50%.
“In our old audit tool we spent 50% of staff time just getting work out to the auditors and tracking results. With ClaimAuditor we can focus on the audit results.”
In most Claims departments, quality audit and cost containment are, at best, marginally connected. Does Audit connect to your Recovery and payment integrity efforts? Does it connect to the root cause needed to FIX payment incidents in the first place? On ClaimAuditor you can see the recovery process from end-to-end – the workflows, process handoffs, communications and analytics are all connected.
“ClaimAuditor gives us the ability to audit high dollar claims before the payment is released – greatly improved our error avoidance capability.”
One of our customers once said, “Without spreadsheets, we could neither audit nor recover claims.” In most audit and recovery processes over 50% of the hours are spent doing something other than directly auditing or recovering claims. Each year we survey our customers to determine which process steps in our platform should be automated – and those are added to our release for that year.
There is no transparency using spreadsheets, emails and blind handoffs in claims auditing. ClaimAuditor tickets, logs, tracks, prioritizes, and alerts users. These features are standard and make it possible to manage the scope of your audit process. You can track how many errors turn into corrective actions or how many calls turn into recovered dollars. Our tools enable you to further customize the platform to optimize your quality and payment integrity efforts.
“I can pinpoint the specific points of pain in our claims operations. I know exactly what risk issues exist, how much they cost us and how to prioritize our corrective actions.”
Algorithms, predefined rules and post-pay audits will only take you so far. Payment Integrity and Cost Containment is finding the payment error before payment is released. Each Cost Containment and Recovery opportunity in our platform comes from your data – your calls, your errors, your contracts, your plan configuration changes. Our tools support your unique needs — identifying, capturing, auditing, prioritizing, routing and tracking. Prepay Process, not Pay and Chase Analytics.
“Now we manage with audit workflows and alerts to problem issues. I can easily see what’ problems we have in provider and plan config and how much that costs us. I have the data to get Leadership’s support for corrective actions needed. “
Auditing is complicated because you need to get your arms around ALL of the areas and departments where claim problems live – and the reasons those errors occur – more importantly – determine what each is costing you. Member calls, provider disputes, refund checks, processor and config errors – all of these can point back to error conditions. ClaimAuditor manages the data to track these various elements. Our reporting brings together the data from all these sources to make it possible to see all the reasons claims are paid incorrectly to take corrective action.
“Many of our products are subject to ever-increasing CMS and regulatory compliance requirements. Datamethod’s approach and software allows us to ‘see’ exactly where we need to focus attention and energy. “
To audit and recover, we touch sensitive data. We use world class security technologies to ensure privacy is securely maintained. Indeed, our hosting setup in the AWS Healthcare Cloud has been rated more secure than our customers’ data centers. Fully HIPPA compliant, dedicated VPN IPSec tunnels, dedicated client networks fully encrypted at rest and in transport, not accessible from outside internet, and Single Sign On SSO integrated with your network.
Most Claim Auditing SaaS platforms built from a single set of requirements to fit a single point in time making growth and future integrations nearly impossible. Not so with ClaimAuditor. From small healthcare payers to the largest national payers with multiple claims processing systems, legacy adjudication systems, and multiple TPA vendors, we have designed our enterprise SaaS platform to integrate and scale painlessly with all your future needs.