Who Should Use This Service
HealthMind’s eAudit is a robust and comprehensive post-adjudication editing service, which supplements the editing within your claims transaction system and addresses system limitations that might exist. As such, it is deployable to a large array of health plan offerings, including At-risk Commercial, Medicare Advantage, Medicaid Managed Care and state Medicaid plans, as well as Third Party Administrators.
Process for Evaluation of Client’s Claim
HealthMind will evaluate your paid claim data for a minimum six-month period to evaluate the potential savings from each of the audit modules relevant to each of your company’s lines of business. During this process, HealthMind will work with your company to validate the completeness and integrity of the data with respect to the requirements of the audit services. HealthMind will also conduct a high-level assessment of your company’s payment policies and contracts to ascertain what exclusions or customizations, if any, need to be put in place prior to deployment. HealthMind will also work with you to determine best strategies for integrating audit results into their claims payment process so no manual intervention by your staff is required to accept DataMetrix audit results.
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