Digitized onsite audit solution enhances process efficiency and PHI compliance


The onsite hospital and pharmacy bill auditing process is an assessment that reviews all documentation related to a claim, including health records, medical bills, prescriptions, and agreements, comparing that information against medical billing data to ensure payment accuracy. During the onsite process, auditors work with provider staff to maintain data security while not infringing on their daily workload.

EXL Health can help healthcare companies by conducting a deep dive into the process, often identifying four main bottlenecks:

  • A dependency on physical paperwork, including printed copies of itemized bills, prescriptions, agreement forms, checklists, and copies of payer policies. This contributes to additional efforts to maintain document security and an increased risk of protected health information (PHI) exposure
  • Frequent connectivity challenges faced by the onsite auditors can increase audit cycle times and cause delays in recording findings and initiating audit findings paperwork
  • Restrictions on audit volumes, including limitations on scheduled times, quantity performed, and dollar thresholds, result in delays in efficiencies, increased travel expenditures, and increased potential opportunities for provider abrasion
  • Reliance on paper mail for required signatures by the provider or retail pharmacy signatory on the findings/no findings and agreement letter.

Human Ingenuity

Leveraging human ingenuity and deep domain expertise, EXL Health’s experts can locate opportunities to streamline and digitize this process, thereby reducing the risk of PHI data leakage, alleviating wasted manual efforts, and decreasing audit cycles time, ultimately enabling more completed audits and greater savings.

Using EXLMINE™, EXL’s audit workflow application, EXL Health designed an integrated offline application that included enhanced features to address areas of common concern. These included digital documentation such as claim forms, itemized bills and agreements, with the capability to download these items prior to leaving the VPN to ensure secure storage and management. This can decrease PHI security concerns, reliance on printed hard copies, and manual errors from handwritten notes.

Offline capabilities enable auditors to view downloaded audit files and documents from the backend system and record audit findings while offline. These can be later synced once connected to internet, improving turnaround times, PHI security, and process efficiencies.

Additionally, a centralized view of audits scheduled and assignments tracking dates, status, and activities can help improve productivity and resource bandwidth.

Integration and connectivity with EXLMINE™ creates an electronic, itemized record of audit findings, including all documents and associated activities, in a structured data format to enable a secure, searchable, and more accurate file package. Additional reporting capabilities, including bill breakdown, auto-calculation, and filtering capabilities, can reduce mathematical errors from auditors manually performing calculations.

Providing auditor teams with digital signature capabilities using signature pads with direct email functionality will enable instant confirmation of an auditor’s onsite findings, reducing audit cycle times. Provider and pharmacy agent signatures can be accepted via email or fax and included within digital records.

These process improvements create operational efficiencies that optimize an auditor’s time while onsite, enable improved cost savings, increase audit completion volumes, and decrease provider abrasion.


Implementing EXL Health’s digitally-enabled solution can help the client improve their onsite audit process in the following ways:

  • ~30-40% efficiency gains in auditor productivity through digitizing the process
  • ~100% PHI compliance, reducing exposure
  • ~99% improvement in turnaround time to share findings with provider
  • ~90% cost eliminated through mail shifting to being processed digitally