AUDIT PROCESS


The following is a basic outline of the process that is involved to get a project up and running:
  1. D&R staff to review and assemble contracts payment data. a. Client to provide copy of contract(s) and D&R will review and assemble a matrix of payment schedule(s).
  2. Compile needed account data from client. a. Provide access to paid claims data. i. Done via remote system access or electronically submitted data. b. Provide access to billing system.
  3. Once underpayments are identified, access to Explanation of Benefits (EOBs). a. D&R staff to locate EOBs and make copies or b. Client staff to provide service and D&R will reimburse.
  4. D&R auditors compare paid claims data to contract terms.
  5. Compile supporting information on identified underpaid claims.
  6. D&R provide client either a summary and/or detail report of findings.
  7. After client review and approval of findings, D&R staff submits findings to carrier on client’s behalf.
  8. D&R staff performs all follow up with carrier to ensure data is accepted and understood.
  9. Once underpayment is identified, recovered payment expected usually within 60 to 90 days.
  10. Once client has received resolved dollars from carrier, D&R invoices client for services rendered.