Claims Processing System
WHAT IS YOUR AUDIT PROCEDURE FOR DETERMINING PAYMENT ACCURACY PERCENTAGE, PROCESSING ACCURACY PERCENTAGE AND FINANCIAL ACCURACY PERCENTAGE AS DEFINED ABOVE?
At Advantek we treat your money as our own and therefore have an extensive audit procedure in place. In addition, we perform a random audit of a statistically valid sample weekly.
HOW ARE ERRORS FOUND DURING AN INTERNAL AUDIT CORRECTED?
Errors found during an internal audit are corrected accordingly prior to payment.
PROVIDE THE RESULTS OF YOUR MOST RECENT INTERNAL PERFORMANCE REVIEW SHOWING THE NUMBER OF CLAIMS PROCESSED, ERROR RATE FOR PAYMENT AND PROCESSING, TURN AROUND TIME, ETC.
The results of Advantek’s most recent internal performance review produced a score of:
100% of all claims paid in 10 days
98.99% Financial Accuracy
99.42% Processing Accuracy
EXPLAIN YOUR PROCESS FOR HANDLING OVERPAYMENTS, OVERCHARGES, EXCESSIVE HOSPITAL CONFINEMENTS, UNNECESSARY HOSPITALIZATIONS, AND OTHER TREATMENTS AND PROCEDURES.
Advantek’s UR department is extremely competent in recognizing and disallowing unnecessary hospitalizations, treatments and procedures. All hospital charges over $10,000 are sent to an outside vendor for a hospital audit. This audit identifies unsupported, unbilled and late charges. Advantek also aggressively audits claims and monitors overpayments.
ARE INPATIENT HOSPITAL CLAIMS ROUTINELY AUDITED?
Inpatient claims are randomly audited for every client. With Advantek’s extensive internal resources, we can provide a thorough and effective traditional hospital audit procedure, if requested.
HOW ARE PROVIDER BILLINGS REVIEWED FOR ARITHMETIC ACCURACY?
As claims are entered, the Advantek system automatically checks for arithmetic accuracy at multiple levels comparing itemized charges to total billed. The system requires that any inaccuracy be corrected before finalization of a claim.
WHAT SAFEGUARDS EXIST TO PROTECT AGAINST CLAIM ABUSE AND FRAUD?
Random and periodic chart audits and medical record reviews are preformed at Advantek to protect against provider fraud. In addition to following prospective clients policies, Advantek has established and maintained separation of duties. Second signatures are required on checks over an agreed upon amount. The Vice President of Operations also reviews 100% of check payments.
WHAT ARE YOUR POLICIES REGARDING AN OUTSIDE CLAIMS AUDIT AND AT WHOSE EXPENSE?
Internal resources are provided by Advantek to assist outside auditors in the audit process.