Verify Auditor Credentials

A TMA physician member received a call from a woman claiming to be from one of the health plans with which the physician contracts. The woman asked to stop by the doctor’s office to obtain information for an audit. When the practice contacted the health plan to verify credentials, the health plan reported it had no employee under the name the woman provided.

It is a good practice to verify credentials of anyone claiming to be an auditor. Also, ask for documentation of the specific information the auditor wants to collect. If the auditor is legitimate, give him or her access only to medical records for the health plan that has authorized the audit. (Note that upon arrival to a physician practice site, all TrailBlazer staff MUST show photo identification to practice staff indicating their affiliation with the Medicare carrier.)

If you have questions about health plan audits, or other payment-related questions, contact TMA Knowledge Center at (800) 880-7955 or knowledge@texmed.org.

 


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