Protect at-Risk
Reimbursement Dollars

Verisma Claims Audit Manager™

Timely response to payer audits is critical, but navigating the process for Medicare, Medicaid, and now commercial audits is growing increasingly complex. Internal staff spend time coordinating medical record requests, document submissions, denials, appeals, reporting, and financial adjustments. The process can quickly become cumbersome and time consuming.

Are you protected against insurance audits?

Verisma Claims Audit Manager is state-of-the-art technology that automates the claims defence process and connects data across the enterprise. When paired with Verisma Release Manager®, you can achieve a unified solution to manage all insurance audits, denials and Release of Information.

Verisma supports you with a team of industry experts and release specialists. Our end-to-end partnership includes flexible service models that adjust to the needs of your existing team.

Protect

Medicare, Medicaid, and commercial insurance reimbursement dollars.

Automate

the audit appeal process, freeing staff to focus on more value-added tasks.

Ensure Compliance

in response to time sensitive deadlines.

Measure

the true impact of audits with extensive real-time reporting.

Core Features

Enhanced Case Management Functionality

Effective audit response management requires real-time account tracking, cross-department collaboration, and timely notification. Verisma Claims Audit Manager facilitates response management in an easy-to-use streamlined package.

Full Interface Automation

The sharing of data across systems automates and streamlines the audit response management process. Verisma Claims Audit Manager has a wide variety of standard and custom interfaces available.

Inbound claim (837) and remittance (835) interfaces supply Verisma Claims Audit Manager with account information.
Outbound HIS notifications provide an event-based post back of notes and indicators to your host systems to coordinate and automate downstream workflows.

Customizable Payer Contract Tools

Commercial payers often have unique rules based on individual provider contracts. As a result, internal processes may need to adjust based on factors such as which internal teams require notification or need to take action. These custom workflows can be defined within VCAM and leveraged throughout the case management process.

Comprehensive Reporting Suite

Our industry-leading reporting tools provide real-time access to monitor and assess all aspects of audit response performance. A wide variety of ad-hoc and pre-built reports cover financial impact, account status and aging, and worker productivity.

Fully Electronic Document Requests and Submissions

Review Contractors (RCs or RACs) issue an estimated 2 million requests each year to healthcare providers for medical documentation and records, according to the Centers for Medicare & Medicaid Services (CMS). Most often, these requests are fulfilled manually through a paper letter sent by the RC followed by the healthcare provider printing or faxing records.

Verisma Claims Audit Manager leverages CMS’ Electronic Submission of Medical Documentation (esMD) program to automate the claims request and submission process. With a secure bi-directional exchange between your practice and RCs, Verisma Claims Audit Manager receives electronic document requests (eMDRs) and triggers the audit response process. For you, this means:

Overall process efficiencies
Improved accuracy
Reduced administrative burden and cost (no burning CDS or paying for shipping)
Significantly expedited claims review process

Request a Demo

Protect at-Risk Reimbursement Dollars