Case Study: Managed Care Plan Uses Tool to Corrects Millions in Payments
Client Background
A large county-sponsored Medicaid managed care plan, one of the largest publicly operated Medicaid plans in the country, dedicated to the well-being of their local community.
The Situation
The client had a backlog of post-payment audits and were performing limited prepayment audits. Reporting on audit results was limited and untimely as well.
As an entity with public oversight, they required a solution with a proven track record. Prior to implementing AccuCAT™, the Moss Adams claims audit tool, their audit process was mostly manual.
The client licensed AccuCAT™ as the technical backbone for their prepayment and post-payment claims audit processes and reporting.
Solutions & Results
The client has been able to utilize AccuCAT™ to greatly enhance its in-house claims auditors’ capabilities—helping make them more efficient and effective.
This has resulted in a much higher volume of claims being audited prepayment and many more errors being identified and corrected before payments and explanations of benefits (EOB) get sent to providers. That change generated significant savings for them each year by avoiding overpayments and reducing rework and provider abrasion.
Recently, with a team of nine auditors and one manager, the client’s in-house clams audit team was able to identify more than $18.6 million in overpayments and $8.6 million in underpayments prepayment using AccuCAT™, generating significant savings that can be redirected to benefit the community.
We’re Here to Help
For more information about how a claims audit tool can help your health care organization, contact your Moss Adams professional.