In the world of risk-bearing organizations, claims leakage audit is crucial for recovering lost revenue. This presentation explores how successful audits can pinpoint claims leakage, ensuring your plan submits accurate risk score data. We will discuss the common causes of claims leakage, effective reconciliation strategies, and how to remediate these issues to recover lost revenue.
Key Takeaways:
- Expectations plans should have for RAPS/EDS reconciliation
- Effectively reconciling submissions in time for sweeps
- Indications of data leakage that affect claims and encounter submissions
- How best to conduct a RAPS/EDS reconciliation audit
- Results of recent RAPS/EDS audits