Until recently, traditional “pay and chase” post-payment claim auditing represented an outsized proportion of the tactics used by payers to ensure payment integrity. With advances in claims platforms, as well as selection and review turnaround times, payers are increasingly looking to implement solutions that prospectively identify and correct errors in the claim lifecycle.
Prepayment auditing analyzes claims during the adjudication flow, allowing payers to avoid -rather than recover- overpayments. This approach is particularly well-suited for high dollar/high risk claims, claims from non-participating providers, and to combat quick hit schemes, but can, and should be applied across all types of claims to maximize outcomes.
Beyond the convenience of more efficient flows, the benefits of prepayment auditing also include:
- Balancing payment integrity programs to reduce excessive reliance on any one tactic
- Lessening provider abrasion
- Increasing savings on both medical and administrative costs.
Historically, prompt payment regulations posed significant barriers to prepayment auditing programs. Noncompliance with these rules results in costly interest and penalties. Also, given the number of nonaudit- related tasks that must be completed during claims adjudication, payers have an extremely limited window in which prepayment auditing can operate.
At SCIO®, we believe time constraints shouldn’t force payers to use a “watered-down” version of the latest auditing techniques and processes. Instead, our clients deserve to be on the cutting edge. To ensure this occurs, we’ve developed sophisticated analytics and a fully staffed team of clinical experts so we could apply the same rigor we’re known for in the post-payment space to prepayment claims auditing.
- Prevent overpayments before they occur
- Reduce excessive reliance on any one payment integrity tactic
- Lessen provider abrasion
- Increase savings on both medical and administrative costs
Interested in learning more about how you can avoid overpayments? Talk to one of SCIO’s industry experts today.