Press Release

WellRithms Subsidiary, Audxguard, Verifies Gag-Clause Prohibition Compliance for Health Plans

Issued by Audxguard

Mar. 14, 2024

PORTLAND, Ore. -- WellRithms, the industry leading payment integrity firm, today announces the launch of Audxguard, a medical claims review service and wholly owned subsidiary developed around the growing demand for transparent pricing within the healthcare industry.

Leveraging the robust infrastructure and data analytics prowess of WellRithms, Audxguard specializes in aiding health plans to navigate the complex landscape of payment terms and regulatory compliance,” says Savannah Quarum, managing director, Audxguard. “With the emerging data transparency landscape, health plan sponsors are now entrusted with the responsibility of understanding and managing their data effectively.”

Since December 2020, the Consolidated Appropriations Act (CAA) has mandated that ERISA health plans cannot be in contractual agreements that include gag clauses, effectively codifying plans’ unrestricted access to their claims data. Failure to comply with the CAA, which mandates annual affirmation, can lead to significant fines and legal consequences, including breach of fiduciary duty.

Audxguard stands at the forefront of facilitating compliance with these regulations offering a suite of services aimed at safeguarding health plans from regulatory pitfalls. Its historical medical claims review product, Audx-C, employs proprietary technology and rule engines to detect overpayments and billing discrepancies, thereby assisting plans in adhering to correct billing and coding standards.

“In today's evolving healthcare landscape, transparency and compliance are paramount,” explains Merrit Quarum, M.D., CEO, WellRithms. “By ensuring compliance with regulatory standards and promoting transparency in billing practices, Audxguard reinforces our mission of Leveling the Paying Field™ for all stakeholders in healthcare.”

Savannah Quarum adds, "Our mission extends beyond mere compliance-- it endeavors to uphold the duties of health plan fiduciaries by ensuring transparency, protecting against financial liabilities and prioritizing the interests of plan participants. The Audxguard team is committed to ensuring that every aspect of healthcare management is conducted with integrity and accountability."

About WellRithms

WellRithms is Leveling the Paying Field™ for purchasers and providers of health care committed to fairness in medical bill reimbursement. The company is recognized as the Master of Payment Integrity™, serving group health and workers’ compensation payors who rely upon its unparalleled technical, medical and legal expertise. WellRithms Shield Indemnification™ is backed by a captive insurance company, transferring all legal and financial liability from the payor to WellRithms. Visit https://www.wellrithms.com.

About Audxguard

Audxguard, a WellRithms wholly owned subsidiary, is a medical claims review service uncovering overpayments, waste and potential fraud in how claims have been paid. The company delivers savings and helps plans step into proactive compliance by verifying gag-clause prohibition compliance, protecting health plans from DOL fines and legal liability, eliminating doubt about provider performance and prioritizing members by protecting the plan. Visit https://www.audxguard.com.

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