Know Your Audit

Know Your Audit (KYA) empowers program integrity personnel to minimize fraud, abuse and deliberate waste of Medicaid Program benefits. The complete case management solutions allow electronic management of investigations, identify overpayments and manage recovery, and generate compliance dashboards and audit reports.
Know Your Audit

Know your Audit to Prevent and detect fraud using audits

  • Provides significant control to program integrity users on the complex investigations managed by them
  • Improves user productivity and throughput on investigations through automation, Workflows, and digitization
  • Enhances the effectiveness of investigations through complete representation of all the associated information
  • Provides executive visibility into the overall health of the program and associated fraud/risks

Key Capabilities

  • Compliance Dashboard Provides an overall view of the different metrics associated with fraud and risks associated with program
  • Overpayments and Recovery Allows identification of overpayments and manage processes for subsequent recovery
  • Claims Analysis Handles intake and triage of claims reported to program integrity team for analysis and recommendation
  • Special Investigations Handles special cases referred by other departments to provide recommendation
  • Configurable Workflow Integrated digital workflow to triage and take decision on recipient as well as special investigation cases
  • Workpapers and Audit Reports Centrally manages all workpapers and reports associated with audits for complete trail