The HealthPlus Medical Audit Department is responsible for reviewing internal and external medical records to verify the reimbursement paid for medical services is accurate, follows approved coding and billing guidelines and is in compliance with Federal and State healthcare guidelines and regulations. Medical audits may be conducted at random or as a result of a billing discrepancy.
The provider may be asked to mail copies of the necessary documentation to HealthPlus; however the office or HealthPlus may elect to schedule an onsite visit for review of medical records.
Medical records are to be mailed to:
HealthPlus of Michigan 2050 S. Linden Rd. Flint, MI 48532 ATTN: Auditing Department
In the event that an overpayment to the provider is identified, the provider will be notified via letter, requesting the amount of the overpayment to be returned to HealthPlus,within 30 days. If the money is not received within 30 days, the outstanding balance will be deducted from future payments, until the entire requested amount is paid in full.
In the event that an underpayment to the provider is identified, the provider will be notified via letter and the money will be added to future payments.
To Appeal an Audit
If you are not in agreement with the findings of a HealthPlus Medical Audit, please review your appeal rights and the process for appealing an audit, located within your HealthPlus contract.
For more information about medical audits, please contact the HealthPlus Manager of Medical Audits and Special Investigations at (810) 230-2110.