What is the post-service, prepayment audit (PPM Audit) status?
A. Accompanying each individual claim warrant, the “Explanation of Benefits” section contains information regarding the reasons for payment, reduction or denial of a specific claim. All claims that are denied on the basis of a PPM Audit will have a denial code message that begins with the words “Denied by post-service, prepayment audit.” The audit will not end until a sufficient percentage of claims are passing the PPM Audit review for a substantial period of time. • Why would a provider’s claims not be listed on their “Explanation of Benefits?” A. Claims subjected to a post-service, prepayment audit (PPM Audit) take longer to process than electronic claims.
Related Questions
- Who can a provider talk to for questions concerning post-service, prepayment audit (PPM Audit) documentation requirements for specific claims?
- Does the post-service, prepayment audit (PPM Audit) status affect all of a provider’s current claims in the system?
- What is the post-service, prepayment audit (PPM Audit) status?
