What are the challenges you face with your current audit in your current audit environment.
A Frustrating Legacy Audit Tool.
A legacy home built audit environment that is built around someone’s version of audit requirements from five or ten years ago that today is unresponsive to evolving business needs, difficult to change, and expensive to support. Even better, you may have two or three stand-alone audit tools used for different audits.
2016 Audit Tool Features Added
Datamethod has added over 300 features a year to ClaimAuditor
for the past 4 years. We listen to and aggressively add the
features that our customers need to support their business
and audit needs. Quit chasing your internal IT department.
Audit Goals You Can't Seem to Achieve.
Why has accuracy not improved? What is holding you back? How much root cause and corrective action related information do you have in your current audit tool? If the answer is mostly “none” – then why would you expect to see an increase in payment accuracy?
Root Cause Analysis
Every error in ClaimAuditor yeilds three root causes. Imagine how much easier it would be to address Copay Errors if you have detailed root causes for 20 of them.
A Focus on Errors and Bad News.
We found 42 financial errors last month and what became of those findings? Instead of being the tip of the spear for process improvement and corrective actions, audit is generally the bearer of ‘bad news’. Shouldn’t you be making sure that every audit finding becomes an improvement?
Attach a Corrective Action to Every Error
Errors are not the end point in ClaimAuditor — corrective actions are. Reporting audit performance for a team using ClaimAuditor is less about counting errors and more about managing and closing corrective actions. Corrective actions and the tools to manage them are what make ClaimAuditor a tool to improve quality — not just a tool to track it.
A Byzantine Audit Process.
What needs to happen to add audits or manage a rebuttal or to run a monthly cycle of accuracy reports for processors? There’s a good chance that less than 50% of your total audit process hours are hours spent actually auditing claims and not in some other manual audit support process. It’s even worse if you have more than one legacy audit tool.
Efficiency Loss on Your Legacy Audit Tool
How many extra steps does your Appeal/Rebuttal process require? How about your reporting and analytics processes? ClaimAuditor has over 2,000 feature releases since it first went live. Each release is aimed at a particular business challenge in the audit process — to make it more effective or efficient or both.
How We Can Help
300% ROI in Year 1.
Reduce Audit Costs by 33%
Reduce your current cost to audit a single claim by an average of 33%. ClaimAuditor has tools to directly increase auditor productivity, reduce reporting time and costs, reduce data loading costs, reduce sampling costs, reduce appeals costs, and reduce processor performance management costs. At the core, ClaimAuditor is about making your audit process less costly.
Identify claims that need to be recovered and tag them for recovery activities. ClaimAuditor allows you to directly route claims for adjustment and tracks to make sure identified claims are actually recovered. In addition to the claims, the errors can also be applied to recovery efforts to identify a broader set of affected claims – enabling substantially larger recovery efforts.
ClaimAuditor unifies all the participants of the audit process, and all their activity and correspondence onto a single tool and process. On many legacy tools audit process is highly variable. ClaimAuditor makes it possible to enforce standards, process and audit transparency, workflow handoffs, coordination, and sox oversight. In ClaimAuditor your team can create a common set of error codes, standard workflow processes, and a single platform for everyone. New audits can be setup in 3 minutes.
ClaimAuditor is not just a tool to measure accuracy – it’s a tool to track and do something about payment and claim errors. Using built-in root cause analysis, corrective action assignment and tracking you reduce reoccurring and hidden problems in your claims payment process.
Most home built audit tools are neither HIPPA compliant nor SOX compliant. In addition to the compliance gaps, many have significant security gaps as well. Out of the box, ClaimAuditor customers enjoy full user activity logging and history display, complete data security and encryption, and dedicated SOX/internal audit login for compliance validation.
Your team can be live on ClaimAuditor in 30 days. Our onboarding process gets your data connected and your people trained with minimum disruption. Our “Gap Analysis” helps you target specific opportunities on our platform. Our implementation helps ensure your investment ROI.
The largest button on every page of ClaimAuditor is the button to request help. We respond to customer service requests in 30 minutes or less. Our 5 minute training video library is world class. Support will not be the hold up to making sure your users fully leverage ClaimAuditor.
We shipped over 25 upgrades and added over 300 features to ClaimAuditor in 2016. All of our customers receive all of the features and upgrades. Audit needs change and our ongoing upgrade process helps ensure the features to support these needs are included in your subscription fees.
Case Study: 100 Hours of Audit
In a typical claims operation, approximately two to five percent of all claims are audited. Across the entire audit process – all participants and all steps – how does 100 hours of effort break down into specific audit activities?
In a typical shop, the chart to the right breaks down 100 hours by audit task.
We have changed these ratios in three ways:
1.Task Automation. Results reporting is fully automated. Every day, every audit reports itself. Claim allocation is also automatic.
2.Task Efficiency. We frequently review each audit and administrative task performed both in ClaimAuditor and in the audit process to identify ways to make auditor and all roles using ClaimAuditor more productive.
3.Task Resources. We overhauled our rebuttal/appeal process specifically to make is possible to manage appeals with more junior resources.