Tighten Up Benefit Claim Processing with Audits
Over the years, many larger employer-funded benefit plans have opted to outsource claim processing to large insurance carriers and pharmacy benefit managers, touting cost savings and superior results. However, the promises need verification by doublechecking claims in a medical and Rx audit to ensure commitments are being upheld and potential efficiencies are being maximized. While…
tfgpartnersThe Frequency of Claim Auditing Matters
The demand for meticulous oversight of medical and pharmacy benefit plans has recently seen a noticeable surge. Large employers sponsoring health plans increasingly recognize the importance of conducting thorough medical and Rx audits to ensure the accuracy of claim payments made by external processors. The practice of outsourcing claim processing, which has been prevalent for…
Let an Audit Tune-Up Your Claim Processing
Employer health plans with outside claim administrators commonly depend on medical claim auditing for needed oversight. When claims are paid out of the house, double-checking their accuracy and that of your processors is paramount. However, there are many efficiencies an auditor can recommend based on knowledge of the field. You want an audit customized to your plan…
Few Things Rival Claim Auditing for Oversight
Something new arises with health planning billing errors and related irregularities when you think you’ve seen it all. Medical claims auditing is one of the most effective ways for employer-funded plans to run oversight and keep their claim administrators working at peak accuracy. Many TPA agreements these days indeed include self-reporting on errors, but how well can…
Beefing Up Health Plan Oversight
When large corporate or nonprofit employers sponsor their employee benefits, they put millions of dollars on the line. Healthcare plans are among the most expensive, and it’s why medical claims auditing and pharmacy claim reviews matter so much. There is a fiduciary responsibility to pay claims accurately, and with outside firms handling it, auditing is…