In this post we will address the prospective audit and bring you how this type of audit works, what the advantages are and how the SAUDI helps your operator implement this type of audit. Continue reading!

Here on our blog, we have already talked about auditing a few times so that you can understand All About a Medical Bill Audit.

This service, which has become essential in the management of healthcare providers, has the main objective of verifying whether company processes are being carried out with the expected quality according to regulatory standards, without falsification or patient safety risks.

There are also several other benefits of carrying out an audit, as we say here, and, in addition, there are also different types of audit:

• Prospective audit;
• Retrospective audit;
• Simultaneous audit;
• Concurrent or on-site audit.

These are the main ones and we even have a post talking just about concurrent auditing. Check it out here!

How does prospective audit work?

Also called prior audit and preventive audit, this type of audit evaluates procedures before they are carried out.

In order to evaluate what will be done, the purpose is detect alarm situations to avoid problems while carrying out the procedures.

In this way, before a surgery, hospitalization, exam, clinical consultation or other diverse procedure, the processes and activities are analyzed in technical and management aspects, also with the aim of avoiding fraud.

Let's talk about these aspects and the benefits involved later.

What are the benefits of prospective auditing?

By regulating and authorizing the execution of procedures after prior analysis of all rules and conditions, such as shortfalls and coverage, potential failures are reduced.

Regarding the technical aspect, you can evaluate, for example, points such as the methodology of the services to be provided, the quality of the processes involved and the level of risks involved in the execution of activities so that they can be reduced and future problems avoided.

As for the administrative scope involved in the prospective audit, there is an analysis of the coverage of the beneficiary's plan, verification of whether the provider has an authorized contract so that the service can be reimbursed, whether it is necessary to hire external suppliers, among other management issues.

With the authorization analyzed and carried out efficiently, this creates greater clarity for the beneficiary in carrying out the procedures, ensuring that they remain loyal to their operator.

And, in addition, for the organization, there is control over the costs of the services offered, which can increase the company's profitability.

Now that you understand the importance of prospective auditing, it's time to tell you how our auditing system can help your operator implement it.

How can SAUDI help your operator to implement prospective auditing?

Automation of rules for authorization of procedures

Using SAUDI, a complete and integrable medical audit system, you reduce the risk of improper authorizations for your beneficiaries through the configuration and use of automatic audit rules.

This means that the technical analysis capacity of requests becomes automated, uses real-time supporting information and has an optimized analysis speed.

This configuration can be optimized and improved over time according to the records and procedures obtained.

Online interactions with providers and beneficiaries and

Our system allows interactions involving both providers and beneficiaries to be carried out via the web, completely online.

This prevents your customers from having to go to the operators to process a request or the need for fully human contact to analyze and authorize a procedure.

There is an increase in the security of decisions that are made because data such as patient histories, providers and medical auditors are accessed in real time and considered for analyzing the request.

Less delay in responding to requests

With this automated and integrated process, the risk of delaying responses to beneficiary requests is reduced, generating fewer consumer complaints.

The workflow also becomes better managed and allows you to have better control of incoming demands.

Once again, it is worth highlighting that digital communication also reduces the response time to requests and favors beneficiary satisfaction, always taking into account accurate information in real time for analyzing requests.

Impacts on the costs of procedures generating better financial results

Finally, among all the benefits that SAUDI can generate for your operator, we will mention the impacts on your management revenue.

Reduction of financial costs with guarantees, through the Reduction of the Provision for Occurring Events/Claims It is Not Warned – PEONA, who refers to the estimate of the amount of events/claims that have already occurred, but which have not yet been notified by service providers (except the single health system) to the operator.

With our system implemented, there is a reduction in assistance costs and accident rates in the administration of your operator.

There is also a reduction in the cost of the application process authorization with the total or partial replacement of call centers, for example.

And yet, another factor that causes results to increase is the reduction in the number of accounts glossed in billing.

Unnecessary expenses that negatively impact financial results are eliminated and benefit your operator's revenue.

Contact us right now!

SAUDI is used by large health plan operators throughout Brazil and today it is the most complete and integrable medical audit system in existence.

The entire process of audit of medical bills It is automated and provides a clear view for operators and service providers, with maximum transparency.

It also generates a reduction in unnecessary costs in the first 3 months of use, as we said, and works throughout the entire process, from requesting authorization to releasing payment.

SAUDI's objective is for health plan operators to become healthier and achieve better results through better management of their healthcare costs.

The result is surprising and has ZERO implementation cost.

Contact with us and find out how our customized solutions can deliver significant results in a short space of time!

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