Specialty Government Program Audits

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In addition to our expansive data mining library, Performant deploys a suite of highly specialized Medicare and Medicaid data mining audits not typically addressed by other COB activities. The algorithms used in these audits were developed by our expert team of federal and state policy specialists who monitor changing regulations to ensure plan compliance. These specialized audits include, but are not limited to:

  • Medicaid/Medicare Duals Repricing Crossovers
  • Interim Payment/Pass Through Payments
  • Medicaid/Medicare Hospice Benefit Coordination
  • Medicare Premium Audit
  • Medicare Disenrollment
  • Medicaid/Medicare Duals Out-of-Network Audit

The specialty audits feature detailed review of highly nuanced and technical government rules and regulations. Performant has applied these audits for health plans with otherwise robust payment integrity operations to identify significant additional opportunities for recovery and cost avoidance.