Claims Audit Management That Protects At-Risk Reimbursement Dollars

Verisma Claims Audit Manager™ helps providers manage Medicare, Medicaid, and commercial audits with less manual work, stronger deadline control, and better visibility into financial impact.

Missed Audit Deadlines Put Reimbursement at Risk

Timely response to payer audits is critical, but coordinating medical record requests, submissions, denials, appeals, reporting, and financial adjustments across Medicare, Medicaid, and commercial audits quickly becomes cumbersome and time consuming. Disparate processes make it harder to meet deadlines, track ADR activity, measure financial impact, and coordinate between revenue cycle, compliance, HIM, and ROI teams, leaving reimbursement dollars at risk.

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A Better Way to Manage Audits and Appeals

Verisma Claims Audit Manager™ (VCAM) helps providers manage payer audits through a centralized platform built to support Medicare, Medicaid, and commercial audit workflows. VCAM uses advanced automation and analytics to create a single source of truth for audit tracking, response management, and reporting across the enterprise. It helps organizations protect reimbursement dollars, improve compliance with time-sensitive deadlines, and reduce manual effort across the claims defense process. With its developing integration to Verisma Release Manager®, VCAM also helps bridge the gap between business office and release of information teams, creating a more connected, end-to-end audit management process.

What Verisma Claims Audit Manager Does for You

Centralize Audit Response Management

VCAM provides real-time account tracking, cross-department collaboration, timely notifications, status models, integrated workflows, and worklists in one streamlined system. That helps teams coordinate audits, denials, and appeals more effectively while reducing missed handoffs and deadline risk.

Automate Data Exchange

VCAM supports interface automation across the audit response process and helps streamline how information moves between systems. Fully electronic document requests and submissions improve accuracy, reduce administrative burden and cost, and help expedite the claims review process.

Adapt Workflows to Payer Requirements

Commercial payers often require different internal steps based on provider contracts and audit rules. VCAM includes customizable payer contract tools so organizations can define payer-specific workflows and apply them consistently throughout the case management process.

Unify Audit and ROI Management

When integrated with Verisma Release Manager®, VCAM helps align HIM and business office teams under a more connected workflow. That can reduce complexity, improve productivity by eliminating duplicate status documentation, and strengthen communication across departments managing audit response and medical record fulfillment.

Protect Revenue. Reduce Burden. Stay Audit-Ready.

Protect Medicare, Medicaid, and commercial reimbursement dollars

Automate the audit appeal process and reduce administrative burden

Measure audit and denial impact with extensive real-time reporting

FAQs

Common Questions About Claims Audit Manager

What types of audits can Verisma Claims Audit Manager support?

VCAM is built to support Medicare, Medicaid, and commercial audit and denial workflows. It was initially developed for Medicare Recovery Audit Contractor activity and now supports broader audit response needs across government and commercial payers, including ADR-related processes, denials, and appeals.

How does VCAM reduce manual work for internal teams?

VCAM helps reduce manual work by centralizing tracking, using worklists and notifications to prioritize activity, and automating data exchange through interfaces such as 837 claims, 835 remittance files, outbound HIS notifications, and ROI-related workflows. This helps teams spend less time on duplicate entry, spreadsheet management, and disconnected handoffs.

Can VCAM work with our existing systems and ROI process?

Yes. VCAM is designed to support interface automation across the audit response process and can connect with existing systems to streamline data sharing and reduce manual effort. It also has a developing integration with Verisma Release Manager®, which helps bridge the gap between business office and ROI teams by creating a more unified process for audit management and medical record fulfillment.

What kind of reporting does VCAM provide?

VCAM provides real-time dashboards and reporting across financial impact, audit status, account aging, worker productivity, and other audit response metrics. Organizations can use both pre-built and ad hoc reports to monitor dollars at risk, assess team performance, and identify audit or denial trends that may need attention.

What size organization can Verisma Claims Audit Manager support?

VCAM is a strong fit for hospitals and larger physician groups, and the underlying implementation experience spans both small community hospitals and large multi-facility health systems. The platform can be configured around the organization’s payer mix, audit volume, workflow needs, and interface requirements, with flexible service and implementation support based on existing internal resources.

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