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Client Audit

Table of Contents

• Overview
• Relevant Parties
• Important Terminology
• Points of Interest

Overview

The Client Audit involves an external auditor working with a Cigna employee to audit claims for specified accounts.

Relevant Parties

• CP: Claim Processor
• CPM: Claim Processor's Manager
• SME: Subject Matter Expert

Important Terminology

• Sample: Comprised of one or more intakes (audits).
• Intake: Comprised of one or more claims. Synonymous with audit.
• Claim: Comprised of zero or more errors.

Therefore, the following hierarchy can be constructed: sample -> intakes -> claims -> errors.

Points of Interest

• There is no routing as in other PBC audit software.
• The audit is completed solely by the CP. The CPM can view details pertaining to audits and can add comments. Otherwise, their say in how the audit is completed is limited.

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