Data mining audits feature the identification of improper claim coding, billing, or payment without the need for medical records review. During data mining audits, Performant applies a library of algorithms to identify claim payments inconsistent with nationally or state-recognized coding standards, violating health plan policies, or containing other clear billing inaccuracies. A data mining finding is triggered when a claim, together with its associated historical claims and other factors, matches the criteria for adjustment.
Performant Healthcare Solutions® data mining audits are divided into four groups:
These groupings include hundreds of edit concepts, such as NCCI edits, unbundling, duplicates, transplant services, MUEs, non-covered services, and multiple procedure reductions.
A distinction of Performant’s services is our commitment to provider outreach on behalf of our health plan clients.
Performant provides technology-enabled audit, recovery, and analytics services in the United States with a focus in the healthcare payment integrity industry.
A distinction of Performant’s services is our commitment to provider outreach on behalf of our health plan clients.
