Last Updated:
December 31, 2023

Posts tagged "medical benefits plan auditing"
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Today’s Claim Audit Reports are Easier to Read

Getting the most out of medical claim auditing for your plan means putting all aspects of the auditor’s report to use. You need to understand the findings quickly; the good news is it’s becoming easier. Two parts of medical (and pharmacy) claim reviews have improved in recent years. One is the readability of the reports, and the other is checking 100 percent of claims – it’s better than random samples. Assessing your self-funded plan’s performance boils down to claim payments and their accuracy. When claims are correctly paid, you better contain costs and service, plan members.    If you’ve been managing benefits plans for some time, you’ve been around for the advances in auditing that have been transformational. The improvements in software and systems have made it easier to audit and have clear reports that point to opportunities. Better auditors will work with you after their review to make systemic corrections that prevent errors from multiplying and flag other opportunities to improve. Medical and pharmacy claims each have hundreds of variables, and opportunities for mistakes come with each. No matter how effective your third-party administrator is, there will be errors.    Adding continuous monitoring services with the same software and […] 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 electronic portion of […] read more
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