Private Payor Audits

Similar to audits conducted by Medicare and Medicaid contractors, providers may find themselves subject to third-party payor audits by commercial insurers. The audit process will vary depending on the third-party payor at issue. As is the case with most Medicare and Medicaid audits, providers likely will receive an initial notice from the payor requesting copies of certain medical records or notification from the payor of its intention to come onsite. In many cases where an onsite audit is conducted, the auditors will hold entrance and exit interviews with provider staff.

Our firm has experience representing providers and suppliers that have been subject to claim denials and overpayment demands made by third party payors (e.g., Blue Cross Blue Shield or Aetna). Our lawyers have successfully defended these types of audits and can assist your healthcare organization with these types of claim denials.