Claims Audit Tool

Implement robust in-house claims audit processes that can potentially save your organization hundreds of thousands to millions of dollars annually with Moss Adams Claims Audit Tool TM (CAT).

CAT enables comprehensive reviews of high-risk areas impacting claims payment and processing accuracy within your organization. The intuitive, user-friendly tool can be used by claim auditors without internal IT support to modify audits performed, or in assigning work to auditors.

CAT is used for pre- and post-payment audits and can be implemented quickly with little maintenance required.

How CAT Supports Heath Care Organizations

Often, claims audit processes are limited in their ability to react and respond quickly to adjudication and payment issues as they arise. CAT can make claims audits more efficient by standardizing how results get recorded, providing auditors detailed claim information they need to perform their reviews, automating manual steps, reducing dependence on IT, and reporting that doesn’t require manual compilation efforts.

This helps organizations audit more claims pre-payment and respond more quickly, driving savings by identifying and fixing errors before claims are released. Importantly, your providers will feel more confident and at ease knowing payments are accurate and consistent.

Benefits of implementing CAT can include the following.

Benefits of implementing CAT

CAT Features

CAT key features include:

  • Powerful data filtering capabilities enable auditors to define their own criteria for examiner, targeted, high dollar, and random sample audits
  • Auto-assign errors to claims, auto-assign claims to auditors, and automate random sample selections
  • Remove dependence on IT to customize extracts and reports as new issues emerge that require new focused audits
  • Customizable audit flags to help auditors identify potential errors
  • Bulk assign errors when system issues are identified impacting large volumes of claims
  • Comprehensive tracking and real-time reporting of audit results including processing and payment accuracy and over/under payment amounts
  • Automated import of pre- and post-pay data extracts into application

How the CAT Process Works

Explore how your organization can put CAT to work:

  • Automate claims data extract from client’s claims warehouse into CAT.
  • Configure auto-filters, auto-audits, or auto-assignments in CAT. Filters or audits to configure can include high-dollar and duplicate claims, targeted vendors, examiner random samples, division of financial responsibility, incorrect application of benefits like copays or coinsurance and contracted rates, auto-adjudicated claims exceptions, health plan audits, corrective action items, and more.
  • Claims auto-assigned to auditors.
  • Auditors access CAT to perform audits, review claims, input audit results and findings, respond to rebuttals, and run reports.
  • Error reports sent to examiners to review and correct erred claims. Examiner disputes errors, supervisor agrees and enters rebuttal.
  • Rebuttals handled and tracked within CAT.
  • Reports on audit results, examiner, and auditor performance generated from CAT.

Request a Complimentary CAT Product Demo

Discover how Moss Adams Claims Auditing Tool TM can help your organization improve and streamline your internal claims audit process. 

A Moss Adams professional will contact you with your preliminary opportunity estimate.

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