Not every plan needs a full-blown payment integrity program to move the needle. Sometimes you just need precision—a fast, scope-defined audit that answers a specific question, proves or disproves a hypothesis, and converts leakage into defended savings without the overhead. That’s exactly what Aegis A La Carte delivers: targeted audits you choose, built to your timelines, tuned to your book of business, and backed by evidence that stands up to scrutiny.

You pick the problem. We’ll zero in on preauthorization friction for a high-cost cohort, test modifier use (25/59/X-modifiers) on fast-growing procedures, validate rate realization against contracted schedules, or dissect a stubborn denial code where appeals keep failing. Want to protect a line of business before renewal? We can run a site-of-care analysis (office vs. outpatient vs. ASC), examine outlier providers, or stress-test telehealth compliance and documentation sufficiency. Each engagement is scoped tightly—one code family, one specialty, one region, one suspected pattern—so you get speed, clarity, and measurable ROI.

Data first, noise off. We start by reconciling billed → allowed → paid for the slice you choose, then attribute variance to the real drivers: edits, medical-necessity rules, prior auth triggers, coding/modifier behavior, documentation gaps, or pure underpayment. Our analysts pair detection with policy-accurate clinical review (plan rules, LCD/NCD) to cut false positives and keep provider abrasion low. The output isn’t a shrug—it’s a defensible finding tied to specific claims, codes, providers, and clauses.

Designed to deploy quickly. A La Carte runs on a sprint cadence: define the slice, load the data, confirm policy sets, and ship a result in weeks, not quarters. You’ll get clear visuals and a one-page narrative that a busy exec can act on—plus the underlying evidence pack for SIU, finance, and provider relations.

What you can ask us to target

  • Preauthorization & Medical Necessity: hit-rate, false positives, and rule tuning; release clean claims faster.
  • Coding & Modifiers: upcoding/unbundling risk; 25 vs. 59 vs. X-modifiers; place-of-service and units/time accuracy.
  • Rate Realization & Payment Accuracy: contracted vs. allowed vs. paid; carve-outs; multiple-procedure reductions; takeback patterns.
  • High-Risk Services: DME, lab/genetics, infusion, pain, imaging, telehealth, behavioral health/therapy.
  • Provider & Network Integrity: license/credential verification, sanctions/exclusions, ownership/affiliation loops, ghost locations.
  • Denial Hotspots: top codes/payers; overturn potential; edit tuning that reduces rework.

What you receive

  • A Findings Deck (exec-ready) and a Detail Appendix (audit-ready).
  • Financial impact: recoveries or avoided loss, by lever.
  • Action list: edits/rules to implement, training to run, provider education to deploy.
  • Optional case files for recoveries and appeals; optional provider letters and talking points.

Why plans choose A La Carte

  • Speed to value: test a hypothesis now; scale winners later.
  • Lower abrasion: evidence-first reviews reduce unnecessary provider friction.
  • Budget control: fixed-fee scope; pay for the slice, not the platform.
  • Operational lift: targeted edits and education cut rework across teams.

When you should use it

  • Before a renewal or product launch, to de-risk a cohort.
  • When a metric moves (spend spike, denial drift) and you need truth fast.
  • To validate a vendor claim—or pressure-test an internal rule—without boiling the ocean.
  • As a quarterly PI tune-up to keep leakage from compounding.

Big programs aren’t the only path to big outcomes. With Aegis A La Carte, you get surgical audits that protect premium dollars, accelerate clean releases, and give your teams clear, defensible actions—without slowing the rest of the business.

Have a high-yield question you need answered fast? Ask Aegis for an A La Carte Audit—we’ll scope it today, analyze it next, and put dollars back where they belong.