End-to-end Claims Review & Auditing Solution

What is Audit360?™

Audit360™ is a scalable and configurable claims review and auditing system built on industry proven technologies and designed by a team of claim auditing experts. Its intelligent integration engine, robust database and intuitive user interface enables allows organizations to streamline the claims review process.

Improving the Entire Claims Audit Process

Audit360™ was built from the ground up to be a comprehensive end-to-end solution.

Improves Efficiency

Audit360™ provides an automated medical claim review process workflow engine (AWE). It’s automated and configurable claim sorting and grouping capability increases assignment and triage speeds. Audit360™ includes an enhanced and easy to use User Interface that quickly allows users to navigate throughout the application.

Improves Quality

Audit360™ includes a comprehensive Business Rules Engine (ABRE) with real-time validation and reporting of errors on every claim that enters into the system. Audit360™ also helps reduce error rates with its flexible QA process and customizable claim review checklist.

Full Traceability

Audit360™ tracks a claim’s entire lifecycle from the moment it enters the system to the moment it is adjudicated, for traceability and transparency. It also increases the visibility of claim data with its powerful searching capabilities and contains a flexible reporting engine that provides instant, real-time visibility into auditor workloads and the audit team’s progress through an audit.

Messaging & Collaboration

Audit360™ promotes secure communication and collaboration through it’s discussion feature which allows auditors to quickly receive requested approvals and answers to questions. All discussion is retained as part of the claim’s audit record and users are notified through the application and through email of outstanding discussions.

Integration Services

Audit360™’s flexible integration engine supports claim submissions in both industry accepted electronic standards and paper format. Processing of electronic claim submissions is fully automated, including acceptance or rejection of the batch and generation of multi-tiered responses.

Security & Compliance

Audit360™ is a secure, reliable and fully compliant product that will allow your organization to meet compliance requirements such as NIST, HIPAA and FIPS.

A 360° view of the entire claims and audit review

Designed by a team of audit experts.

Audit360™ comes feature rich right out of the box so that your organization can focus on going right to work. Take advantage of Audit360™’s document capture to support paper based claims or go completely automatic with electronic document support. Powerful processing workflows, detailed search and reporting, and robust security and compliance make Audit360™ the premium choice for a complete claims review and auditing solution.

Document Capture

Paper Claims – Audit360™’s scanning functionality captures paper claims and other documents supplied by third party organizations and imports them into the system. These documents are then available for auditors throughout the lifecycle of the audit process, in the same manner as electronically received documentation.
EDI – Audit360™ also supports EDI 837 Health Care Claim X12 message transactions. EDI support provides the ability to greatly increase the speed of transactions in an open source standards-based environment. Audit360™ meets 5010 HIPAA requirements for transmitting electronic health claims, in particular supporting the 837P (Professional), 837I (Institutional), and 837D (Dental) formats. Claims are accepted electronically in EDI (837), PDF, JPG, and PNG formats.
Attachments – Audit360™ allows auditors to directly upload additional supporting documentation as attachments to specific claims.
Quality – Audit360™’s integration engine automatically validates incoming data and provides real time reporting of any errors.

Processing

Workflows – Audit360™’s flexible assignment and routing functionality allows for customized workflows across the team.
Claim Categorization – Audit360™’s integration engine includes customizable sorting schemes that allow claims to be automatically categorized during ingestion.
Claim Adjudication – Audit360™ includes a customizable claim review checklist tailored to the type of review being performed, which allows auditors to easily capture their results in a common format. Customizable error codes allow auditors to select error reasons from a common list. Audit results are stored and accessible throughout the system for easy retrieval.
QA – Audit360™ has a flexible and configurable QA engine that allows varying percentages of claims (as little as 0% or as much as 100%, or anywhere in between) to be routed into the QA process. In addition, separate QA levels can be set for individual users whose work requires enhanced oversight. The QA process allows auditors to correct their own mistakes, but also allows QA personnel to request and monitor edits to a particular claim’s results in a controlled manner.

Searching

Claim search – Audit360™ gives users the ability to quickly locate claims using a wide variety of search parameters, including data points on the claim, users who have touched the claim, and audit results of the claim. Search results encompasses large data sets or can be filtered to specific claims.

Reporting

Auditor Productivity Report – Audit360™ allows the management team to view detailed productivity numbers for each auditor on the team. The report provides the insight necessary to accurately track the progress and estimated completion date of an audit.
Claim Assignment Report –Audit360™ allows the management team to view real time workloads of each auditor, providing the data necessary to efficiently manage workloads across the team.

Security and Compliance

HIPAA compliant
FIPS compliant
NIST compliant

Integration Security

Data Submissions – All electronic data submissions must be securely encrypted and must pass through the Audit360™ secure gateway.

Contact Us Today to Get Started!

Get in touch with us to learn more or schedule a free demo to see how Audit360™ can help your claims and review process.