Post Payment Review
CGS may perform a post-payment review of claims, meaning that medical documentation is requested for claims that have already been processed and paid. Post payment review can be done in cases where a h igh error rate and/or potential overutilization has been identified through data analysis. Post payment review can be done at the provider’s location, or in CGS’s Medical Review Department. Upon review of the documentation, CGS Medical Review clinicians will make a determination that either affirms the original payment, or denies the payment (in part or in full). If any part of the claim is denied, an overpayment is assessed, and funds are recouped from the provider.