These days, nearly everyone in health plan management would agree that 100-percent claim audits are more accurate than random sampling. The improved accuracy means that a healthcare claims audit will flag more errors, discover additional overpayments, and lead to more precise reports. For plan sponsors, it's an opportunity to conduct oversight of third-party administrators and pharmacy benefit...

Large employers care for their employee's health care needs with self-funded plans for sound financial reasons. But those plans need medical claim audits frequently to stay on track. In the early days, when audits relied on random samples that were less accurate, they were used for regulatory compliance. But today, they are a valued management tool, and auditors check 100-percent of claims paid...

There might have been a time when health plan auditing services were considered a regulatory and compliance issue without much more consideration. However, that's all changing now as continuous improvement in audit technology and systems has unlocked far greater potential Today, self-funded plan sponsors see the value in frequently auditing their claim payments, if not monitoring them...

Large corporate and nonprofit employers that sponsor medical and prescription plans for their employees have a lot on the line. The third-party administrators (TPAs) and Pharmacy Benefit Managers (PBMs) that process their claims handle millions of dollars. Therefore, medical claim auditing services are essential when starting with a new claim processor. These initial reviews are also known as...

The trend for many years among larger employer-funded benefit plans has been to outsource claim processing. Large insurance carriers handle it with sophisticated capabilities amid promises of cost savings excellent results. But only a healthcare claims audit can verify if the commitments are being met and every opportunity for efficiencies leveraged. The third-party administrators providing the...