Audit detail
Claim integrity sampling review
Targeted sampling of claim batches to surface duplicate charges, mismatched codes, and unexplained adjustments.
Purpose
When you already know a problem exists in one specialty or one insurer channel, a full-cycle audit may be more than you need. This sampling review concentrates on integrity checks inside a defined batch.
Included
- Agreed sample size (typically 80–200 claims)
- Duplicate and split-charge detection within the batch
- Procedure–diagnosis pairing spot checks
- Short findings memo with examples, not a full remediation programme
Not included
Training workshops, multi-site rollouts, or insurer negotiation support.
Next step
Ask about sampling and note the specialty and insurer channel you want examined.