When you notice unusual claims from a specific provider, what should you do next?

When you notice unusual claims from a specific provider, the best course of action is to consult with your immediate supervisor. This step is crucial because supervisors are typically more experienced and familiar with the protocols associated with handling potentially fraudulent or unusual claims. They can offer guidance on the correct procedures for investigating the situation further, ensuring that any actions taken are consistent with organizational policies and regulatory standards.

Consultation fosters a collaborative approach to addressing possible fraud, waste, or abuse concerns. By involving your supervisor, you help ensure that any follow-up is handled appropriately and that the necessary reporting mechanisms are activated if needed. This approach also helps maintain a clear chain of responsibility and documentation for any claims under scrutiny.

The other options do not provide a structured or compliant way to handle the situation. Rejecting the claims outright may not be justified without first understanding the reason for the unusual charges. Similarly, contacting the provider directly could lead to unintended consequences and may not follow your organization's escalation procedures. Waiting for a month is not proactive and would allow potential issues to persist without investigation or resolution. Therefore, consulting your supervisor is the most responsible and effective initial step.