2022-03: DME and Home Health Post - Pay Claim Audits
Date: 02/14/22
Louisiana Healthcare Connections has contracted with Performant Recovery, Inc. to conduct a review of claims that have been submitted by facilities and paid for by the MCO. Provider reviews will be conducted to determine if providers are conforming to appropriate billing practices and whether Louisiana Healthcare Connections has been billed appropriately for medically necessary, covered services.
This claims review is in accordance with the contract that exists between providers and the MCO. Should overpayments be identified as a result of this review, an adjustment to claims may be processed. Performant will engage providers in a comprehensive audit/clinical review using a team of registered nurses, certified coders, and audit analysts with Medical Director oversight.
About Performant Recovery, Inc.
- Performant is a business associate as defined by the Health Insurance Portability and Accountability Act (HIPPA) of 1996. In accordance with HIPPA, we have written agreements with Performant, assuring compliance with HIPPA privacy and security requirements in the handling of our members’ information.
- Performant offers audit services to payers of healthcare claims which includes identification and recovery of underpayments and overpayments resulting from erroneous claims submissions. The company serves government and private organizations that outsource their services to agencies whose core competencies are in the examination and resolution of healthcare related assets.
- Performant’s overall audit team includes MD’s, Registered and Licensed Nurses, and Certified Coders, each trained in Medicare (including LCDs/NCDs), and/or payer specific commercial policies.
As part of the review process, it will be necessary for providers to submit all requested documentation to the address below within 30 calendar days of receipt of the audit notice. Providers must respond promptly even if they are unable to locate the requested documentation. Performant reserves the right to request additional records at a later date if deemed necessary. Failure to submit the requested medical records may result in administrative denial and recoupment of claim reimbursement. Should you have questions or would like additional information, please feel free to contact Performant Recovery at (844) 308-3781.
Performant Recovery, Inc.
P.O. Box 3568
San Angelo, TX 76902
This new audit process will be effective May 12, 2022.