Contract Compliance Benefits

Inpatient Facility Claims billed under Per Diem, Stop-Loss and Case Rate contracts

CCA audits are performed by pharmacists, nurses or physician assistants and validate clinical rules for contracted services

Proprietary, rules-based screening for claims with high potential for savings

All reviewers are clinicians with expertise in the area of audit review

Combined review of the treatment plan and delivery of services and the contract intent

All CCA reviews reflect the client's specific contract language

SMCA applies expert clinical and contractual knowledge that can make the difference

Contract Compliance Audit (CCA) is an intensive audit review service that looks at paid home infusion, durable medical equipment and renal (dialysis) claims. CCA identifies the excess delivery of products, services or overpayments due to misapplied or misinterpreted contract terms. CCA reconciles claims not only based on the correct contractual reimbursement, but often, savings are realized by our ability to verify and reconcile the actual physician order versus what was billed on the claim.

Home Infusion (HI) Therapy

Durable Medical Equipment (DME)

Renal Dialysis Services

High Cost Outpatient Rx Injectable (non-PBM claims)