Provider - Payment Integrity Audit Services

Recover lost dollars & enhance your revenues through a retrospective review of your zero balance claims, with zero upfront investment!!

Data Marshall's 'Payment Integrity Audit services' help identify the payment variances through retrospective review of claims & recover them. As Payer contracts are becoming increasingly complex, increasing the likelihood of payment inconsistencies, manual review & analysis is needed to complement the Contract management systems in identifying the payment variances. We are a pioneer in the Payment Integrity Audit services, with experience of deep domain expertise of over 7 years.

Why DataMarshall

  • High level of proficiency in the Payer & Provider domains, offering key insights enabling the identification of trends, fraud & abuse and wasteful healthcare expenditure.
  • Faster recovery of lost revenue, through precise analysis & corroborating documentation, with an equal emphasis on recovering low dollar amounts.
  • Deep-dive approach to research & analysis through our proprietary data mining tool & predictive analytics.
  • Recovery of millions of lost dollars and a success based pricing model - effectively we benefit only if the client benefits.
  • Proactive identification of payment variances, leading to accurate future payments.
  • Aid in improving the efficiency & accuracy of the front end processes, through inputs & insights provided by Data Marshall.
  • Minimal involvement of the client, allowing the client to focus on their core business.
  • Underpayments can occur across various payers; hence we do not restrict our review to only one specific insurance type such as Medicare, Medicaid, Managed Care and/or Commercial insurers. Our review encompasses claims of all the insurers.

Approach

Highlights

  • Hospitals spread across in 15 states.
  • Detect payment variances and flag underpayments, incorrectly closed claims, inappropriate denials and rejections, and provides critical insights into the payer contracts.
  • Underpayments can occur across various payers; hence we do not restrict our review to Medicare/Medicaid, Managed Care and/or Commercial insurers.
  • Unique 360o approach to claims review to identify potential underpayments.

case studies

Underpayments identified for a New York Based Hospital.

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