Clinical Audit Services
Clinical review you can stand behind.
Sagility helps health plans evaluate post-pay claims for medical necessity, level of care, and clinical appropriateness. Expert clinicians apply evidence-based guidelines and payer policies to reduce risk and support defensible audit outcomes.
Overview
As part of Sagility’s Payment Integrity Suite, our Clinical Audit Services support post-pay review programs that require clinical expertise and documentation-based analysis. These audits focus on whether services were medically necessary and delivered at the appropriate level of care.
Clinical Review
- Validate medical necessity and level of care
- Review clinical documentation against payer policies and evidence-based guidelines
- Identify inappropriate utilization and clinical compliance risk
- Support defensible recoveries and audit findings
- Leverage medical records and itemized bills, as required
Decades of Partnership, Performance, and Progress.
Clients stay with Sagility for a reason: deep-domain expertise, measurable outcomes, and a true partnership approach. Purpose-built for healthcare and trusted by the nation’s top health plans and providers, we bring decades of experience and a proven ability to simplify operations and deliver lasting impact.
Straight from the Source
We’re more than a vendor, we’re a partner. Here’s what our clients have to say:
Sagility brings deep operational and process expertise and pivots quickly in response to emerging needs. The team is highly receptive to feedback and takes action with minimal direction.
Associate Director, Payment Integrity,
National Health Plan
Sagility is a team I can count on to give their best effort and work diligently to complete any assigned task. They make excellent use of available resources to deliver work efficiently, effectively, and accurately.
Operations Specialist, Implementation, and Strategic Projects,
Regional Health Plan
Their strength lies in their flexibility and adaptability — stepping in to support any situation and responding quickly to issues. The Sagility team in Bangalore is a tremendous asset to the organization. The office environment and team culture make it feel as though you are walking into a client facility when on site.
Vice President, Operations,
Healthcare Financial Services Company
Case Studies
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Insights & Resources
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