Health care worker working at a laptop

As a health payer / insurer, you need a robust claims integrity process that improves coding accuracy and minimizes healthcare provider abrasion. CGI sets the standard with an industry-leading 96% appeal-uphold rate.

We provide access and transparency of audit findings to you and your hospitals and providers to create a more robust claims integrity process. The relationships we build with you and your provider community not only reduce provider abrasion, but ultimately improve coding accuracy through partnership and education.


Read our brochure

Hospital inpatient

  • Coding validation
  • Clinical validation
  • Short stay outliers
  • Outlier charge review
  • Medically necessary admission
  • Discharge status validation
  • Related readmission
  • Avoidable readmission
  • Hospital acquired condition review

Hospital outpatient

  • Canceled procedures
  • Inappropriate modifier usage
  • Medical necessity
  • Policy compliance
  • Device credit review
  • Line-item charge review
  • Trauma team and emergency room levels
  • Observation hours
  • Diagnostic/therapeutic radiology

Professional providers

  • Facility/professional mismatch
  • Ambulance services
  • Anesthesia billing
  • Inappropriate modifier usage
  • Durable medical equipment billing
  • Evaluation and management review
  • Policy compliance
  • Medical necessity

Recovery audit process
CGI's recovery audit process starts with secure receipt of claims and continues through analysis, audit and provider coordination.