QA/Professional Review
In addition, Correctional Health Management staff provides a high level of QA and professional review services. During the first 30 days of a new contract, we audit 100% of all claims to identify suspect billing practices and or contract issues. If we identify any errors, that provider is flagged so we monitor all future claims until the issue is resolved. We will audit a minimum of 10 claims per provider during this period. If we have not received at least 10 claims from a provider, we continue to monitor all of that provider's claims until we have looked at a minimum of 10 claims. After the initial 10 claims/thirty day period, we monitor 25% of all claims for the next 90 days.

All ER/Inpatient claims over 10k will be audited for the life of the contract. Again, any issues identified during this period flag all future claims from that provider to be audited until the issues are corrected. After that 90 day period ends and for the life of the contract we audit 10% of all claims. Unless we find issues with a claim, the typical turnaround time for a submitted claim is less than 48 hours.