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- Medical Claim Payment Disputes Land in CourtThe 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...0 Comments 0 Shares 753 ViewsPlease log in to like, share and comment!
- The Good News in Medical Claim AuditingTechnology 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...0 Comments 0 Shares 784 Views
- The Experts Agree: Audit Your Plan's ClaimsThere 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...0 Comments 0 Shares 817 Views
- Improved Accuracy Heightens a Claim Audit's ValueSelf-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...0 Comments 0 Shares 757 Views
- Don't Overlook the Potential of Claim AuditingA sudden spike in claim costs gets the attention of medical and pharmacy sponsors, and the coronavirus pandemic was one of those events. Today, health plan auditing services are reviewing what happened for plans that did not have continuous monitoring of claim payments in place. There were many new variables as testing and treatments reached their peaks. Utilization rates were up for nearly all...0 Comments 0 Shares 783 Views
- Employer-Funded Health Plans Need Claim AuditsThere are well-established and financially sound reasons large employers sponsor medical and prescription plans for their employees. But the cost exposures are significant and careful oversight is necessary. Medical claim audits have become especially important as claim processing has been moved out of house to third-party administrators and pharmacy benefit managers. While most are large...0 Comments 0 Shares 727 Views
- The Increased Span of Medical Claim Auditing TodayAs the scope and price of medical services and medicines continue to strain medical and pharmacy benefit plans, audits help them keep up. Today medical claim auditors consider an ever-widening number of covered services and medications – plus the negotiated prices, acceptable maximums, and rebates that can come with them. The claims third-party administrators and pharmacy...0 Comments 0 Shares 817 Views
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