Auditing for provider Fraud, Waste, Abuse and Error, is a core component of cost containment. It involves detecting and correcting provider error; overbilling and ‘creative’ billing techniques to make sure you are only paying for legitimate claims.

Leading Edge audit specialists are constantly monitoring for the newest, “creative” and aggressive billing techniques providers and medical billers may use. We regularly update the rules in each plan’s audit engine. Our team also has a deep knowledge of medical and pharmacy coding.

The team corrects every flagged claim immediately. When there is a major issue, we meet with our client to review our findings, educate them on the issue and make recommendations on how to remedy. We then go to the network for permission to speak with the provider directly to correct the error or overbilling issue.