Created for payers, TPAs, RBOs, and payviders, AccuCAT™ enhances robust in-house audit processes that can potentially save your organization hundreds of thousands to millions of dollars annually.

AccuCAT is designed to improve efficiency, reduce errors, and add value to your in-house claims processing and auditors. AccuCAT enables comprehensive reviews of high-risk areas impacting claims payment and improving processing accuracy within your organization. This intuitive, user-friendly solution can be used to drive processing improvements, enhance audit reporting capabilities and root cause analysis, expand the audits performed, and prevent errors before claims are paid.

AccuCAT is used for pre- and post-payment audits and can be implemented quickly with little maintenance or support required.

How AccuCAT Supports Your In-House Claims Audit Process

Often, audit processes are limited in their ability to react and respond quickly to issues as they arise. Audit processes can be inefficient, static in nature, and produce limited results for the time invested in them. AccuCAT can transform your audit processes to make them significantly more robust, efficient, and value added.

By streamlining and automating audit processes, reducing manual steps, making audit processes more flexible and effective at targeting risk areas and responding to new issues as they arise, auditors can focus more of their time auditing claims that generate errors, leakage, and rework.

As a result, organizations are able to audit more claims pre-payment and respond more dynamically as issues arise, driving savings by identifying and fixing errors before claims are released and more timely after they were paid. Importantly, your providers will feel more confident and at ease knowing payments are accurate and consistent.

AccuCAT will streamline and automate audit processes. Additional benefits of implementing AccuCAT include the following:

AccuCAT Features

AccuCAT key features include:

• Powerful data filtering capabilities enable auditors to define criteria for examiner, targeted, high dollar, ad-hoc, and random sample audits  
• Auto-assign errors to claims, auto-assign claims to auditors, and automate random sample selections
• Customizable audit flags to call potential errors and issues to auditors attention
• Remove dependence on IT to customize extracts and reports as new issues emerge that require new focused audits
• Bulk assign errors when an issue is identified that impacts multiple claims
• Comprehensive tracking and real-time reporting of audit results including processing and payment accuracy and over/under payment amounts
• Automated import of pre- and post-pay data extracts into application

Enhanced AI Predictive Analytics Capabilities

AccuCAT’s artificial intelligence (AI) predictive analytics integration can bring even more efficiency to your claims audit processes and enhance your auditors’ capacity to review large claim volumes.

• Auditor efficiency gains. Review more claims with increased efficiency.
• High accuracy. AI-generated predictive scores can direct you to errors and avoid false positives.
• Seamless integration. No third-party tools required.

Auditing Solution Success Stories for Payers and RBOS

Organizations covering 35,000 to 2 million lives have leveraged AccuCAT to enhance their auditing processes.

Discover how AccuCAT can help your organization improve and streamline your internal claims audit process.

A Moss Adams professional will contact you to schedule a demo to assess if AccuCAT is right for you.