Claim Audit Information for Providers

Understanding Claim Audits

Information for Healthcare Providers



Why Claims are Audited

Audits of provider claims are a core service provided by of HMS, delivered out of the extensive cost-containment expertise developed over more than four decades of experience. Due to the company’s experience and industry reputation for accuracy, health plans and providers turn to HMS for audits to discover claims that are coded or billed incorrectly, or where it seems other payment errors are likely.

Navigating the Process

This site is designed to help providers and their staff understand the healthcare claim process, provide instructions for completing the audit, answer questions and provide solutions.

 For More Information

If you have questions, need further instructions or wish to speak to an HMS representative, contact information for speaking to an HMS representative are available on the Provider Relations page. You can find specific instructions for submitting a rebuttal or appeal of an audit determination on the Rebuttals and Appeals information page.

Healthcare Cost Containment is Our Business

HMS is a leader in healthcare cost containment. Since 1974, we’ve helped commercial, Medicare Advantage and Medicaid managed care plans reduce or control cost, minimize risk and improve quality. Today, our 250-plus health plan clients, 45 state Medicaid and dozens of federal plan clients cover more than 100 million Americans. We save these plans billions of dollars each year.

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