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How Technology Improved Medical Claims Auditing

When it comes to technology, perhaps no industry has been so helped by the advent as the healthcare industry

In particular, the claims audit process has evolved leaps and bounds with the development of software for the job.

Processing various claims by hand is tedious, painstaking, and frankly, takes too much time out of your day. In the healthcare industry, there are more things to worry about than audits – but how can you when they take up most of your time?

With the right software, you’ll be on your way to rearranging your priorities while still maintaining the accuracy that’s crucial to your job. 

Let’s take a look at how technology has helped shape the claims audit revolution and the amazing things it’s done for the industry.


The most obvious way in which technology has enhanced the claims audit process is by making it much more efficient. This one’s something of a no-brainer; a quicker, more accurate way of doing things will naturally lead to more efficiency.

Prior to the advent of technology, the billing and claims audit process was slow and tedious. With technology, things run much faster as we can process these requests in large batches.

Additionally, the software used gives us the chance to find any errors quickly. There’s no reason to do any of this by hand, though it’s always good to lend another set of eyes to a digitally-processed document.


The claims audit process had limited security in the past. With most of the work being done by hand, employees had access to personal information and financial contacts. 

While the risk of fraud was relatively low, the fact that the risk still existed was something of a turn-off – especially as physical copies of bills and claims were being stored.

Technology allows these items to be stored in the cloud. That means there’s no physical record on hand and no saved copy on someone’s personal computer. Everything is able to be stored electronically, and only those who needs access to the information have it.

The cloud is password protected, meaning that matters of security have become much less of a worry. Storing claims and bills is a much less risky process.


Sometimes, when things are done by hand, it’s possible for us to overlook errors multiple times. This can cause discrepancies between what we see and what the patient sees. 

However, while humans can be prone to error, computers typically aren’t. Most claims audit software both allows auditors to double- and triple-check their work and will bring attention to any glaring errors.

This means that there are fewer mistakes made, and those which are made are caught and fixed with ease. This means that there’s less chance of a claim being rejected, as the mistakes are typically caught before the claim is finalized.

This all ties right back into efficiency. With accuracy picking up, companies and auditors now have much more time to focus on other priorities.


The number of claims that need to be processed isn’t dwindling. Think about a number of claims received today, then think about processing the same number a couple decades back.

It’s a terrifying thought, isn’t it? You can almost see the physical mountain of claims stacking up. The thought of handpicking which claims to audit is even more daunting.

However, with the current software, it’s much easier. The process and task are still complex and require precision, but we can process claims much faster now. 

The claims with the highest error probability are traditionally the ones chosen for a claims audit, and with the speediness of the current process, we’re able to assess which ones are appropriate to audit instead of wasting time on trivial matters.

It can also provide you with data regarding how your organization is faring.


While there are some standard processes in the healthcare industry, each company is going to approach different processes with their own unique flair.

The advent of technology allows healthcare organizations to take whatever approach to claims audits that they wish. Regardless of how they choose to employ their own personal process, they can be certain that the software chosen will do its job properly.

This allows healthcare organizes an unparalleled level of freedom when it comes to conducting audits. 

It also allows managers to track the process every step of the way by providing a centralized dashboard. This means that anybody with the proper login credentials can watch an audit through every step.


When processing an audit by hand, it’s sometimes difficult to notice whether or not there’s an issue with any documentation or billing until you’ve already put in a vast amount of time into the project.

The great thing about technology for claims audits is that it takes this risk out of the equation entirely. The technology is so efficient that it’s capable of catching errors before even the most thorough human eyes.

Depending on the software used, it may even be able to resolve these errors without disregarding the work you’ve already put into it. Most software will even give each issue a new ID number. This means that managers or anybody involved can track each issue through the steps in the process.

Technology’s changed the claims audit climate

Technology has changed everyone’s lives in ways previously thought impossible. Ask anyone whether or not they expected to be holding miniature computers up to their ears as phones, and surprise will make itself apparent very quickly.

It’s important for all aspects of the medical industry to remain on top of technological developments. The further technology develops, the more lives can be saved.

As for the technical side of things, technology has allowed us to focus on different priorities for different organizations. Meanwhile, we haven’t had to make any sacrifices to accuracy.

If anything, technology has made us more accurate and ensured that we’re only auditing claims that hold water.

If you have any questions regarding the use of technology and software for claims audits, please don’t hesitate to contact us.

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Apex EDI, Inc.
556 E Technology Ave
Orem, Utah 84097
Support: (800) 840-9152
Sales: (801) 383-0388
Fax #: (801) 642-0333
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