Medical Claims Review & Audit

QHM's medical claims review and audit service is a very detailed process. QHM compares the services and supplies documented as utilized in the medical record against the charges listed on an itemized bill. An audit begins when a claim is flagged by QHM as suspicious or inaccurate and then submitted to the auditing department for a full analysis of the case.

Claims Audit: Claims Audit: The QHM auditor ensures the codes used and prices charged are correct and accurate. This auditing requires review of the medical records, reports, claims and insurance policy. The auditing process involves extensive research of patient records, line by line comparison of itemized bill with the medical records, and negotiation with hospital to remove the inaccuracies. This service is available to U.S. and International claims.