Claims auditing and recovery
As a leader in healthcare claims auditing and recovery for nearly 20 years, CGI services and software – CGI's Customized Audit System (CAS) – have helped Medicare, Medicaid and commercial payers recover more than $1.8 billion in lost payments due to improper claims. We also offer anti-fraud solutions to help detect, remedy and prevent claims fraud, pre- and post-payment.
Our expertise and experience includes:
- Serving as one of the four permanent Medicare Recovery audit contractor (RAC) firms, covering 7 states and 8.5 million beneficiaries in Region B
- Performing reviews and audits on behalf of Medicaid, Medicare and commercial payers
- Breadth and depth of knowledge of a variety of payment methodologies, state and federal regulations and medical policies and contracts unique to each payer
- Proven claims audit and recovery services, powered by CGI's Customized Audit System (CAS), that have been used to audit approximately 30 million covered lives by payers ranging in size from 60,000 to 9 million members.