AuditShark Platform

AuditShark Platform

A Comprehensive Audit Platform for Health Plans

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THE PROBLEM

Auditors are under pressure to effectively review a greater number of audit cases within tighter timeframes, all while working within increasingly constrained budgets.

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DO THESE ISSUES SOUND FAMILIAR?

Clinical, DRG and Itemized Bill Review Audit Challenges

Accuracy: Auditors are drowning in clinical jargon, working with copy-pasted shorthand on tight deadlines. This increases error rates and leads to missed DRG savings as scrutiny is reduced to minimize friction.

Efficiency: Siloed systems and huge data sets bog down audit teams with time-wasting admin tasks. Lack of a centralized chart repository adds delays and duplication, further amplifying provider abrasion.

Capacity: Audit teams are being pushed to their limits with outdated systems, manual processes, and limited resources, leaving no room for growth.

Pre-Pay

Lead Access & Prioritization: Eligibility data is spread across various sources, but system limitations make it hard for plans to leverage all leads, causing missed savings opportunities.

Verification: Verifying leads is slow and tedious, resulting in delays, expired claims, and lost savings.

Centralized Primacy Engine: Without a unified primacy logic engine, manual determinations drag out cycle times and spike error rates.

Post-Pay

Claims Analysis & Recovery: Many teams process claims ‘first in, first out,’ wasting time on low-value claims, driving down ROI.

Rules Management: Navigating state regulations and provider exclusions without a flexible platform leads to errors, compliance issues, and provider abrasion.

Adjustments & System Updates: Manual claim and eligibility adjustments across multiple teams result in delays, errors, and extra costs.

Quality and Compliance Audit Challenges

Claim Selection: Static selection criteria trap teams in repetitive findings, missing out on new and emerging issues.

Efficiency: Aging systems, disconnected tools, and manual processes constrain audit teams that are already at full capacity.

Root Cause Correction: Without a single platform to manage findings, rebuttals, and escalations, accountability is lost, leading to recurring issues and wasted resources.

OUR SOLUTION

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The One-Stop Audit Solution

AuditShark is the first complete platform dedicated to payment integrity audit professionals, designed to help health plans easily scale their internal audit capabilities.

Only AuditShark has all the major audit types on a single platform, empowering health plans to reduce point-solution fatigue and the costs of integrations and get more out of their investments by leveraging the same platform across the enterprise.

What could faster Audit Reviews
mean for your team?

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OUR PLATFORM

AuditShark is a cloud-based payment integrity audit platform designed to help health plans manage their own internal audit functions so that they can maximize efficiency, accuracy, and margins.

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Key Features

  • COMPREHENSIVE PLATFORM
    All audits and all work on a single screen
  • DATA, ANALYTICS & REPORTING
    Easy access to holistic, rich data
  • RULES, EDITS & WORKFLOWS
    Full control for compliance and efficiency
  • PRIORITIZED WORK QUEUES
    Focus on what matters most to your business
  • AI-POWERED COMPREHENSIVE DOCUMENT REPOSITORY
    Charts, letters, contracts, etc.
  • AI AND NLP
    Augmented intelligence with Clinical NLP and AI methods
  • AUTOMATED WORKFLOWS
    Maximum efficiency with minimum administrative effort

BENEFITS

  • Maximum Productivity
  • Maximum Accuracy
  • Reduced Costs
  • Improved Control & Quality
  • Right-Sized Workload Balancing
  • Complete Data Access & Analytics

What could a comprehensive approach to
auditing mean for your business?

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