Providing end-to-end recovery audit services for state Medicaid health plans

Five U.S. state Medicaid health plans needed to manage the end-to-end payment audit workflow, detect and prevent fraudulent payments and manage data.

CGI ProperPay solves these challenges by managing audits, aligning with payer /insurers policies, issuing findings to providers and providing reporting capabilities.

Value delivered

• Provided support for Medicaid audits for health plans in five states
• Leveraged machine learning capabilities, developed a model to prevent false positives and generate new audit scenarios
• Furnished a centralized repository of audited case results and a state-of-the-art system, streamlining the auditing process
• Implemented a provider web portal to enable transparency

Learn more about CGI's Payment Integrity Services

CGI’s innovative suite of payment accuracy solutions delivers the best complex-audit-review overturn rates in the market, along with proactive feedback to prevent future errors, enabling payers / insurers to continuously ensure claims payment accuracy while maintaining the highest level of compliance.