Last Updated:
April 30, 2024

Posts tagged "medical benefits plan auditing"
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Minor Errors Add Up in Claim Payments

Every medical claim paid is a complex endeavor. One way for employer-funded plans to police the accuracy of their payments is a healthcare audit. Reviewing each payment made by a third-party administrator or pharmacy benefits manager is a crucial oversight function. Catching and correcting significant error patterns is vital, but so is finding individual mistakes. Taken together, minor errors add up to substantial sums for many plans, and flagging and correcting them makes a difference. It supports cost containment efforts and improves member service when claims are paid correctly with consistency. The audit setup is one of the most crucial parts of the process because everything flows from it. A one-size-fits-all approach won’t yield the benefits of a customized configuration. The nuances of each plan need to be addressed by the audit software, ideally by someone with equal expertise in medical claims and audit techniques. It’s why all claim auditors aren’t alike, and selecting the best makes a difference. They bring years of expertise and a specialized approach that adds value. There is no substitute for working in the field daily, staying current with trends, and continuously improving. As claim audit technology and systems become more sophisticated, the electronic portion of […] read more
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Minor Errors Add Up in Claim Payments

Every medical claim paid is a complex endeavor. One way for employer-funded plans to police the accuracy of their payments is a healthcare audit. Reviewing each payment made by a third-party administrator or pharmacy benefits manager is a crucial oversight function. Catching and correcting significant error patterns is vital, but so is finding individual mistakes. Taken together, minor errors add up to substantial sums for many plans, and flagging and correcting them makes a difference. It supports cost containment efforts and improves member service when claims are paid correctly with consistency.   The audit setup is one of the most crucial parts of the process because everything flows from it. A one-size-fits-all approach won’t yield the benefits of a customized configuration. The nuances of each plan need to be addressed by the audit software, ideally by someone with equal expertise in medical claims and audit techniques. It’s why all claim auditors aren’t alike, and selecting the best makes a difference. They bring years of expertise and a specialized approach that adds value. There is no substitute for working in the field daily, staying current with trends, and continuously improving.   As claim audit technology and systems become more sophisticated, the […] read more
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Claim Auditing Takes on a New Importance

What can an employer-funded health plan do best in the face of skyrocketing costs and extraordinary events (the coronavirus pandemic)? Several things exist, but reviewing claim payments should be near the top. Medical claim audits are an excellent plan management tool for many reasons. They provide oversight of third-party administrators, find and flag irregularities, and help ensure claims are paid consistently and correctly. Numerous financial and plan management benefits occur in the short and long term. Finding mistakes before they are million-dollar problems always helps. Most specialist claim audit firms today double-check 100 percent of claims and review them from every possible angle. The power of its software and methods is unrivaled, and it has a system to overview a claim administrator’s process. The biggest and easiest fixes are systemic improvements that prevent future errors. But today is also common for individual issues to be flagged that are well suited to recovery, which includes overpayments of payment in error. Plans emerge from an audit much better, and typically the price for the service is much less than the recoverable errors it finds and reports. Today’s claim audits also produce reports that are actionable and easy to understand. Compared to the […] read more
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