Audit workflow

Audit workflow is the essential part of Smart Audit Master applications. It is the proven and best way of controlling audit process among users and removing papers from the process completely. You can monitor the entire audit progress from one screen.

Workflow

1. New claims are passed to an audit queue to auditors.
2. Auditors audit claims that have been assigned to them. They work against checklist/Error Code List and enter any necessary comments on the claim process.
3. Analysts respond the errors and comments from auditors and send the claims back to auditor if they do not agree with the audit.
4. Auditors have a chance to respond to the analyst's disagreement second time. Auditors may remove or upheld their decision. Auditors pass the claims to Quality manager if auditors confirm the errors.
5. Quality Managers process the claims through the appeal panel and finalize the audit results. They may decide whether the errors should be counted against the analysts or against the department.
6. System generates error trend analysis periodically.

Analysts are prearranged to auditors and auditors to Quality Managers/Supervisors. Analysts must respond to auditors audit results within pre-determined hours such as 24 hours or 48 hours. Same restrictions apply to auditors and supervisors in order to expedite the process if pre-paid method is your account payable setup.

You can have checklist groups and checklist lines within each checklist groups. Some examples are as follows:

Checklist Groups:
Accidental Injury
Authorization
COB
Cost Containment
Duplicates
Entry Coding
Eligibility
Incorrect Pay Calculation
Provider Contractual
Process Errors
Provider Payee
Provision Exclusion

Checklist Lines
Workers Compensation Not Investigated
Workers Compensation Claim Paid in Error
More…

Each checklist line has error categories. The categories are Payment Error, Processing Error, and Financial Error. A checklist may be in a single error category or multiple error categories.