Reimbursement Review. CMS-Aligned Payment Accuracy.

Aegis partners with state and federal programs to strengthen payment integrity, reduce fraud, waste, abuse and ensure accurate reimbursement across complex provider networks. We bring evidence-first audits, CMS-aligned policy expertise, and operational playbooks that speed clean payments while stopping what shouldn’t be paid.

Ensure every in-network provider is paid correctly and consistently with CMS rules. We test rate realization, policy alignment, and edit effectiveness to eliminate under- and over-payments—and provide a clear path to compliant, timely reimbursement.

What to Expect:

  • Contract/fee schedule validation vs. CMS and state guidelines
  • Allowed/paid reconciliation by code, modifier, place of service, and setting
  • Prior-auth and medical necessity linkage; frequency/duration limits
  • Pre and post-pay edit tuning to minimize denials and rework
  • Underpayment detection and “proof-of-payment” verification
  • Provider feedback loops and corrective-action monitoring

What to Expect from Us:

  • Reimbursement accuracy report (contracted → allowed → paid) with gaps
  • Edit/rule change list, implementation guidance, and QA checks
  • Provider communication packets and audit-ready documentation
  • Accurate, CMS-aligned payments; fewer reversals and appeals
  • Faster clean releases, improved provider satisfaction, and compliance confidence

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Let’s chat about how we can work together.

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