Sleep Soundly During Audit Season: 60-Second Evidence Response
Evidence-linking technology reduces claim audits from 15-30 hours to 60 seconds. Defend medical necessity, eliminate denials, and strengthen payer relationships.
The Hidden Cost of Claim Documentation Requests
Payers need documentation quality to reduce denials and improve provider relationships. Current systems create adversarial friction.
Claim Documentation Requests
Providers spend 15-30 hours per audit gathering evidence, straining relationships and delaying payments
Medical Necessity Disputes
Lack of supporting evidence leads to denials, appeals, and defensive downcoding that costs both sides revenue
Risk Adjustment Accuracy
Incomplete HCC documentation creates RAF score gaps and quality measure failures in value-based contracts
Audit Season Stress
Providers dread payer audits due to time-consuming evidence gathering, creating adversarial relationships
Evidence-Linking: The Missing Layer in Payer-Provider Trust
60-Second Audit Defense
Every billed service links to timestamped audio proving medical necessity. Respond to payer audits in 60-90 seconds instead of 15-30 hours of manual chart review.
95% Reduction in Claim Disputes
Claims include built-in evidence trail, eliminating documentation requests and appeals. Payers process claims faster, providers eliminate defensive downcoding stress.
HCC Accuracy for Risk Adjustment
Real-time prompts capture complete chronic condition documentation. Evidence-linking defends RAF scores during retrospective audits with 7-year audio retention.
$100K-$300K Annual Savings
Reduced denials ($50K-$150K), faster payment cycles (30 days → 15 days), improved HCC capture, and elimination of defensive downcoding losses.
Why Payers and Providers Win with Evidence-Linking
Evidence-Linking for Claim Defense
Every billed service links to timestamped audio proving medical necessity. Respond to audits in 60 seconds instead of 15-30 hours.
7-Year Audio Retention
HIPAA-compliant audio storage for long-term audit defense and retrospective chart reviews for quality improvement.
HCC Capture Optimization
Real-time prompts during documentation ensure complete risk adjustment coding for accurate RAF scores and shared savings.
Prior Authorization Efficiency
Include audio evidence with PA requests to reduce denials and back-and-forth, accelerating approvals by 40-60%.
Quality Measure Automation
Automatic HEDIS, Stars, and MIPS tracking during visits eliminates end-of-year scrambles and improves bonus eligibility.
Medical Necessity Documentation
Progressive HPI builds context across visits, creating stronger medical necessity narratives that survive scrutiny.
Success Patterns Across Value-Based Contracts
ACO Physician Practices
Shared Savings Contracts
- 60-second audit response saves 20-40 hours per quality review cycle
- Evidence-linking reduces claim disputes by 95%, protecting shared savings
- HCC capture optimization increases RAF accuracy for proper capitation
- Quality measure tracking improves MSSP performance scores by 15-25%
Medicare Advantage Practices
Risk Adjustment Documentation
- Real-time HCC prompts capture $200K-$500K additional revenue per 1,000 lives
- 7-year audio retention defends retrospective RAF audits instantly
- Stars measure automation improves quality bonus eligibility
- Medical necessity documentation reduces denial rate from 8-12% to 1-3%
Commercial VBC Contracts
Quality Metrics and Cost Control
- Evidence-based PA requests reduce denial rate from 22% to 6%
- Faster claim resolution (30 days → 15 days) improves cash flow by $50K-$150K
- Quality measure compliance protects 5-10% of contract value at risk
- Audit defense eliminates defensive downcoding that costs $75K-$200K annually
Real-World Workflows That Transform Payer Relationships
60-Second Audit Response
Respond to payer audits with timestamped evidence in seconds
- 1 Payer requests documentation for E/M level or procedure code
- 2 Click audit defense button next to billed service
- 3 System generates report with timestamped audio proving medical necessity
- 4 Export evidence package (PDF + audio clips) in 60-90 seconds
- 5 Send to payer, eliminating 15-30 hours of manual chart review
Prior Authorization with Evidence
Reduce PA denials with audio-backed medical necessity
- 1 Complete patient visit with ambient documentation
- 2 Generate PA request with evidence-linked clinical narrative
- 3 Include timestamped audio clips supporting medical necessity
- 4 Submit to payer with built-in audit trail (40-60% faster approval)
- 5 Reduce PA denial rate from 22% to 6% industry-leading rate
HCC Capture and Risk Adjustment
Maximize RAF scores with complete chronic condition documentation
- 1 System reviews patient's historical HCC diagnoses pre-visit
- 2 Real-time prompts during documentation for condition updates
- 3 Evidence-linking proves each HCC diagnosis with timestamped audio
- 4 Quality assurance checks ensure specificity (e.g., diabetes with complications)
- 5 Defend retrospective RAF audits with 7-year audio retention
Specialized Solutions for Payer-Provider Challenges
Risk Adjustment Documentation
HCC coding accuracy for Medicare Advantage and ACO contracts
Value-Based Contract Compliance
Quality metrics and cost control for shared savings programs
Medical Necessity Documentation
Evidence-backed claims that survive payer scrutiny and audits
Prior Authorization Efficiency
Audio evidence reduces PA denials from 22% to 6%
Appeals and Audit Defense
60-second response time vs 15-30 hours manual review
Quality Metrics Reporting
Automated HEDIS, MIPS, and Stars measure tracking
How Much Are Claim Disputes Costing Your Practice?
Calculate savings from reduced denials ($50K-$150K), faster payments (30 days → 15 days), improved HCC capture, and elimination of defensive downcoding losses.
Payer Integration Support
Data Integration
Connect with payer systems for real-time gap lists, quality measure tracking, and performance reporting.
Contract Configuration
Customize documentation workflows based on specific payer contract requirements and quality measures.
Training & Adoption
Comprehensive provider training on value-based care documentation and HCC capture best practices.
Performance Monitoring
Ongoing monitoring and optimization of documentation quality and payer performance metrics.
Related Solutions for Value-Based Care Success
Audit Defense
Evidence-Linking
Respond to payer audits in 60 seconds with timestamped audio evidence, eliminating 15-30 hours of manual review.
Medicare Billing
AWV, TCM, CCM, RPM
Capture Annual Wellness Visits, Transitional Care, Chronic Care, and Remote Patient Monitoring revenue opportunities.
HCC Risk Adjustment
RAF Score Optimization
Real-time prompts capture complete chronic condition documentation, defending RAF scores with 7-year audio retention.
Stop Dreading Audit Season: See 60-Second Evidence Response
Join ACO, Medicare Advantage, and commercial VBC practices already saving $100K-$300K annually with evidence-linking technology.
Evidence-linking technology that transforms adversarial payer relationships into collaborative partnerships.