Audits
Premier Prizm Solutions' nurses conduct hospital audits and provider bill audits to determine accuracy, medical necessity and causality. In addition, the level of care and length of stay are reviewed against standardized guidelines.
Our Audit process consists of:
- Determination of appropriate method of review (on-site or off-site) based on UCJ guidelines and carrier specific policies
- Request of medical records and billing information
- Completion of audit including utilization and financial negotiations
- Recommendation of a peer review, if warranted
- Application of PPO if appropriate
- Completed report with signed Letter of Agreement from the provider
