PAYER AUDIT / OVERPAYMENT RESPONSE
An insurer says you owe money. You need clarity before you respond.
Heaude organizes every allegation, affected claim, document, deadline and payer decision into one structured workspace for you and your attorney.
Move from audit panic to a case you can understand and act on.
Your recordsYour attorneyOne organized caseNo outcome predictions or automated legal conclusions
Redacted real-case sampleAnthem SIU / overpayment review
Rebuttal reviewed
Requested entries60
First demand$64,733
Later review27 / 30
Later components$567,097
What became clear?
The file contains an earlier documentation demand, an extrapolated 97155 component, a provider rebuttal, a later 30-line review and later enrollment-related components. Heaude keeps each stage and calculation separate.
March 13 demand59 / 60stated unsupported
97155 component$64,573stated as extrapolated
Later review27 / 30unsupported after rebuttal
Core lessonSeparate stagesclaim count ≠ demand calculation
THE PROBLEM
Audit response becomes expensive when the case has to be reconstructed from scratch.
Payer letters, spreadsheets, clinical documentation, enrollment records, rebuttal responses and provider explanations often arrive in different places. Heaude creates one claim-by-claim structure before the team spends hours figuring out what belongs to what.
1Capture the audit
Payer, claim universe, exposure, deadlines, findings and current review stage.
2Map what changed
Initial finding → evidence → rebuttal → payer response → final status, with independent issue categories.
3Give counsel a case
Not a folder. Counsel gets issue chronology, evidence gaps, enrollment timing, exposure and the response record.
ONE CLAIM, PLAIN ENGLISH
Status → reason → money at risk → next evidence
Initial reviewSupported
Rebuttal reviewNot supported
New issueNPI enrollment on DOS
Next evidenceEnrollment effective-date record
WHY THIS IS DIFFERENTThe provider sees the simple story. Counsel keeps the forensic trail.
Heaude is not trying to make providers interpret payer coding language or make legal conclusions for attorneys. It organizes the factual record so both sides can work from the same case.
TWO ENTRY POINTS. ONE CASE.
Providers can start directly. Attorneys can send the intake link to the client.
The case price follows the audit, not the buyer. An attorney can open a client case, send the provider one guided intake link and receive the audit back in a structured workspace.
PROVIDERI received an audit.
Set up the practice, payer, audit scope, claim volume, exposure and issue categories. Invite counsel now or later.
- Guided audit intake
- Plain-English claim status
- Evidence gap checklist
- Financial exposure separated from error-rate math
Provider path →
ATTORNEYI need the client to send me a usable case.
Create the matter, send the provider intake, then review a structured case instead of reconstructing one from emails and attachments.
- Multi-client portfolio
- Provider intake links
- Counsel-only notes
- Claim / rebuttal / enrollment chronology
Attorney path →
AUDIT RESPONSE RESOURCES
Understand the issue before you organize the response.
Start with the type of review in front of you. Each guide separates factual preparation from the legal conclusions reserved for counsel.
ATTORNEY DISCOVERYFind counsel working in healthcare audit defense.
The directory includes basic profiles drawn from verified public professional sources. Unclaimed profiles do not imply participation, endorsement or affiliation. Attorneys can claim and expand a profile after identity and authority verification.
Browse the directory →
SIMPLE CASE PRICING
One payer audit. One fixed case fee.
The fee follows the payer's asserted exposure—not attorney hours or the number of claims. Provider and counsel access, attorney invitations and directory access are included.
UP TO $100,000 ASSERTED$999per payer audit case- Provider + counsel workspace
- Claim / finding matrix
- Rebuttal and decision history
- Evidence and enrollment map
Organize my audit
$100,000.01–$250,000$1,499per payer audit case- Same complete case workflow
- Provider + counsel access
- Attorney invitation included
- No percentage of recovery
Organize my audit
ABOVE $250,000 ASSERTED$1,999per payer audit case- Same complete case workflow
- Exposure-based fixed fee
- Directory access included
- No hourly platform fee
Organize my audit
What counts as one case?One payer audit or demand, including its associated claim lines, rebuttal submissions and later payer decisions. More than 500 claim lines, multiple payers or unstructured data requires a scope review and may require a separate quote.
AUDITREADY MEMBERSHIP
Keep the records organized before the next audit arrives.
Members receive an approximately 70% lower case fee after the eligibility period. Membership is for ongoing readiness; it does not retroactively discount a known or existing audit.
SOLO$99/moup to 2 rendering providers- Ongoing audit-readiness workspace
- Member case fees: $299 / $449 / $599
- Member rate after 90 continuous days
- Known audits excluded
Stay audit-ready
PRACTICE$249/moup to 10 rendering providers- Practice-level readiness workflow
- Member case fees: $299 / $449 / $599
- Member rate after 90 continuous days
- Known audits excluded
Stay audit-ready
LARGER ORGANIZATIONCustommore than 10 rendering providers- Organization scope review
- Multi-team readiness workflow
- Eligibility confirmed before billing
- Annual option available
Discuss scope
Member-rate eligibilityMonthly members qualify after 90 continuous days. Annual members may qualify immediately for audits not known or received before enrollment. Existing or known audits use the standard case fee. Eligibility is confirmed before billing.