The SIU initially set a target of 50 for this measure, but learned that it wasn’t realistic to set a static target number as the number of providers audited quarterly is based on the provider type being audited, and identified criteria that can vary from quarter to quarter.

This measure is important because the more providers SIU interacts with the more cost avoidance can be realized. 

SIU seeks to measure the effectiveness of SIU contact with providers to determine if the provider changed their billing patterns going forward after SI involvement.  Data analytics or other leads will identify potential subject area and providers to audit.  SIU strives to audit a variety of providers, educate as appropriate, and recover funds when necessary.  Provider group/specialty, defined criteria, e.g., over 100 claims in a month, and resources would affect the number of providers identified each quarter.

COVID had an impact on this measure as providers were not subjected to proactive audits during that time. 

Last updated:  02/07/23

• Medicaid Providers
• Gainwell Technologies
• Provider Member Relations Unit
• Clinical Operations Unit