ComplyTrack Claims Audits

Proactively manage every facet of your claims-based audit process

Combined with the powerful and flexible ComplyTrack platform, the Claims Audit workflow allows you to respond both proactively and retroactively to auditors and Recovery Audit Contractors while simultaneously managing multiple rounds of appeals. Manage the entire life cycle of any financial audit and use workflow automation to increase efficiency and accuracy with the Audit Detail Manager (ADM), engineered specifically to handle the high-volume, time-sensitive, and complex workflow necessary to satisfy record requests, process determination letters, and navigate the rebuttal and multi-tiered appeal process.

Designed to put you in control of the complete audit life cycle, Audit Detail Manager provides the flexibility to manage pre- and post-pay audit requests from Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), the Medicaid Integrity Contractors (MICs), Zone Program Integrity Contractors (ZPICs), or commercial payer audits.

Know your regulatory stance

  • Guarantee consistent, proper, and timely handling of audits across entire organization by implementing secure enterprise-wide Software as a Solution.
  • Identify denial trends on increasing governmental and private payer audits to proactively correct issues and safeguard revenue.
  • Quantify audit appeal success/failure to focus resources on winnable appeals.
  • Quickly see possible audit losses to ensure reserve funds are properly allocated.

Make the right decisions at the right time

  • Track both RAC and non-RAC claims-based audits from letter to last appeal without an investment in additional staff.
  • Increase efficiency and accuracy by focusing the efforts of audit response teams on the overall process, eliminate redundant manual processes, and document the audit impact for facility management and board members.
  • Maintain audit trails for all correspondence, detailing claim-level tracking from initial request through multiple levels of appeal.
  • Reduce workflow/headcount by managing audit and appeals submissions electronically without tying up resources for copying and logging correspondence with outside consultants and auditors.

Get the information you need, where and when you need it

  • Detect, analyze, report on, and predict trends using standard and customized reports for every level of detail throughout the process.
  • Add ADMConnect to track and manage the decision workflow through every appeal with EHR, with real-time electronic communication.
  • Use ADMGateway, with esMD capability built right in, to help handle the high volume of record requests.

Named Best in KLAS for RAC Management in 2012 and 2013​​

Description: EHR IntegratedPlatinum Certification Level—
Full electronic integration of
data and image transfers between
ADM and EHR.


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