Healthcare Claims Auditing Software

Written by Kimberly Clark
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The Health Insurance Portability & Accountability Act of 1996 (HIPAA) made healthcare providers legally responsible for making sure all the information in the claims they submit is safeguarded and protected against unauthorized viewing and modifications. Thus, to ensure the accuracy of submitted claims data and to track any necessary changes made to the original claim, a healthcare provider might consider investing in healthcare claims auditing software. This type of product would also allow them to monitor the approval and payment status of any claims.

To be truly effective, the auditing software should have the ability to preserve a copy of the claim in its original format. Plus, it should maintain a detailed log of all the system and user edits. And because of the privacy and security requirements of the aforementioned healthcare regulations, the auditing software should even keep a record of everyone who simply took a look at the claim.

In order to accomplish these objectives, access to the auditing software should be password protected. It also needs the ability to assign different permission levels for read and write privileges. Additionally, the software ought to have an electronic signature feature coupled with a time and date stamp.

Auditing Claim Status

Auditing software also allows the healthcare provider to easily determine the current status of their claims. Whether it has been paid, is still being processed, or has been denied should be clearly laid out. For those claims that have been denied, the healthcare provider should be able to use the auditing software to extract and analyze the claims information, and possibly use the findings to develop a "lessons-learned" procedure, which will hopefully help them avoid the same pitfalls in the future.


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