It's essential to consider the value of medical claims auditing in reviewing the claims your plan has paid because it can provide valuable insights, improve performance, and ultimately save money. Proper management is crucial for large corporate and nonprofit employers who self-fund their benefit plans. Ensuring accuracy in prior authorizations and the payment process is essential for...

Self-funded medical and pharmacy benefit plans have many good reasons to audit, given the financial exposure for their sponsors. It's why today's highly accurate healthcare auditing companies are in greater demand. Companies and large nonprofits were hit with extraordinary costs during the coronavirus pandemic, and reviewing claim payments makes sense. When you work with a medical...

The big money but generally quiet world of medical claim payments is suddenly making news as large self-funded plans are suing their claim administrators – which are well-known health insurers. It is expected to encourage more self-funded plans to run a healthcare audit to double-check their payments. Generally speaking, in business, it is a peculiar scenario when one company is hired to...

There are few corporate services you can engage that put dollars back into your budget, but medical claims auditing can be one of them. For large employers self-funding their benefits plans, finding overpayments and other claim payment irregularities adds up to big money. For example, it's routine for a medical and pharmacy claim review to flag recoverable errors adding up to four...

Technology has advanced in every area, and for medical claim auditors, it’s meant more thorough claim reviews faster and with less human oversight. It’s not to say that it’s entirely digital enterprise because human insight continues to create considerable value. But the power of today’s electronic claim reviews is unprecedented. The level of detail they produce is...