Challenges

Why is configuration audit and testing so hard?

What are the challenges you face with your current process.

There is No Tool, only Process.

Spreadsheets to audit, faith that your auditors are reviewing everything, errors emailed, hours spent on rebuttals, no confirmation contracts are fixed before production, no visibility into team performance or workflow status. Sound familiar?

In today’s world you wouldn’t adjudicate claims without a claims platform system, so why should you still using spreadsheets to manage your system configuration changes? It’s the first of its kind. A dedicated auditing, testing, and workflow platform for claim configuration changes built by the industry experts in claim audit software.

A Frustrating Audit Checklist.

Each contract change or fee schedule update may require hundreds of validation checks to confirm its setup correctly. How do you know your auditors are checking each one, every time? How much does a small error cost on a high volume hospital system?

ConfigAuditor was designed around checklists, specifically your checklists. Define and customize your checklists for your benefits, contracts, fee schedule changes or any other configuration item you wish to audit and test. Turn on or off workflows, from auditing, testing, audit the tester, and audit the auditor. Efficient workflows with full logging to ensure your processes are followed each time, every time.

A Byzantine Audit and Testing Process.

How many manual steps are in your configuration auditing, testing, and validation process today? There’s a good chance less than 50% of your total audit and testing process hours are spent actually doing auditing and testing and not in some other manual support process.

Efficiency loss on your legacy process:

How many extra steps does your Appeal/Rebuttal process require? How about your testing and audit the tester processes? ConfigAuditor is designed for process efficiency while ensuring all of your system changes are accurate. With support for unlimited configuration activities that may need workflows to be audited, tested, audit the tester, or audit the auditor the possibilities are endless.

Zero System Controls to Ensure Accuracy

How do you know if an audit checklist item was missed? What happens when a testing scenario if forgotten and a mistake slips through? With most payers Auto Adjudication rate over 90% a simple mistake can mean millions of dollars in payment errors. Is this a system to leave to spreadsheets?

ConfigAuditor uses workflow management and audit controls to automate and ensure many of the human elements that cause process failures are removed. At Datamethod we’ve taken our leadership in quality claim audit software systems and automation and applied them to configuration auditing and testing.

How We Can Help

50% Reduction in Benefit and Contract Errors

Relationship

Rolling in 30 Days

Case Study: 100 Hours of Audit

In a typical claims operation, 75% of all configuration changes 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. Configuration allocation is also automatic.
  • 2.Task Efficiency. We frequently review each audit and administrative task performed both in ConfigAuditor and in the audit process to identify ways to make auditor and all roles using ConfigAuditor more productive.
  • 3.Task Resources. We overhauled our rebuttal/appeal process specifically to make is possible to manage appeals with more junior resources.
Data is loaded, samples are created — 9%
Claims are allocated — 3%
An application is maintained — 3%
Auditors Audit configuration — 34%
Errors are assigned and managed — 10%
Errors are responded to — 11%
Appeals are heard and managed — 16%
Results are published and reported — 14%