Why perform a Workers Compensation claims/invoice audit?

• Identify and recover lost Workers Compensation Fund dollars.

An audit of paid Workers Compensation healthcare dollars is the only method of determining that the claims are paid accurately. HCCI will review 100% of paid claims in the areas of State Fee Schedules, duplications, covered services, and claims administration fees.

A Worker Compensation claims/invoice audit can be performed electronically with onsite validation when necessary to resolve outstanding findings with the claims administrator.

• Validate employer’s monthly invoice from Workers Compensation claims administrator.

Workers Compensation invoice billing from the claims administrator can be complex and difficult to validate the terms in the service agreement. HCCI will validate that the client is paying the agreed service fees in addition to validating the provider rates paid for the related medical services. 

• HCCI will assist the employer in the recovery of overpayments agreed by the claims administrator.