AuditGuru™ - Feature Specification List

Settings supported:

  • Hospital
  • Clinics
  • Long Term Care
  • Physician Practices
  • Ambulatory Surgery Centers
  • Mental Health

Types of audits:

  • Coding (Inpatient, Outpatient and Physician)
  • Coding Staff Evaluations
  • Clinical Documentation
  • Defense Audits
  • Linked Claim Audits (Institutional and Physician)

AuditGuru™ users:

  • Health Information Management
  • Compliance
  • Revenue Cycle
  • Nurse/Coding Auditors
  • Case Management
  • Billing Office
  • Consultants, External Auditors, Contractors


  • Claim repository based on submitted claims (837 files)
  • Initially loaded with historical claims
  • Automated uploads of current claims
  • User defined selection of the audit population and sampling methodology
  • AuditAssist automatically edits claims
  • Performs over 3,000 charge capture and compliance edits on outpatient claims
  • Identifies potential RAC issues
  • OCE and MCE editing
  • ICD-10 Training Utility
  • Compare coding of original vs. audited claim
  • Calculate change in payment
  • Medicare – DRGs, APCs (OP and ASC), physician fee schedule
  • Fee schedule payers
  • Percent of charge payers



Contact Information Contact The Wellington Group for more information