Claim Audit Information for Providers

Provider Relations

Clinical claim audits for appropriate reimbursement is a complex process for providers and health plans. When providers receive a medical request notice due to an audit, HMS can help them understand the process and provide instructions and context.

The HMS provider relations team is available to support communication between providers and plans throughout the process, including answering questions and addressing concerns.

Opening a Conversation

Providers can contact HMS with their concerns and questions. One-to-one discussions, often conducted by telephone, are ideal opportunities to provide education. These conversations can alleviate provider unease with the audit process, help them understand what is required to complete the audit process, and understand HMS’ findings. These conversations often lead to greater provider understanding and satisfaction with our work and our results.

Call the HMS Provider Relations line at (866) 875-1749, Monday-Friday, to make letter inquiries, ask questions about the audit process, verify claim status or to ask other questions.

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