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About random audits

Updated on April 26, 2021

Smart Claims Engine lets you audit random claims based on predefined criteria. Once the logic for an audit is set within the application, its corresponding event code is applied and the claim is routed to the appropriate work queue for the event code. Random audits are applied on claims that have completed the adjudication and are available and ready to be paid.

There are eight random audits currently configured in Smart Claims Engine:

  • 4955 - Billing Provider
  • 4956 - Member
  • 4957 - Claim Type
  • 4958 - Contract Number
  • 4959 - Claim Amount
  • 4960 - Random Number
  • 4961 - Examiner
  • 4962 - Provider Paid Amount

Business user information

This section explains how to:

  • Configure a random audit.
  • Update the threshold value for an audit.
  • Delete a random audit.

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