JGI clients are assured by our staffing model that they will have true professionals with years of experience leading their claims audits. JGI does not use contract staff to complete any portion of claims audits, and our most experienced staff handle all site visit management and other critical functions of projects.
With claims audit careers spanning up to 20 years, our professionals have gathered expertise that is critical to operating in this industry including personally auditing every national carrier with ASO business and BCBS plan in the country and reviewing thousands of provider contracts and plan documents.
Our staff draw from an exceptionally deep and broad knowledge bank in claims auditing, but they also operate within a culture that defines success much broader than project accomplishments. People define the quality of our service, and our unique culture makes working together a pleasure.
Custom modeling of the client benefit plan(s) including patient portions, benefit limits, noncovered services
JGI analyzes dozens of claim attributes suggesting payment of services twice including traditional duplicate claims, duplicate lines, overlapping inpatient claims
We assess both missed coordination opportunities with Medicare and commercial plans and also the accuracy of payments made as the secondary plan, subrogation is related concept as well
The broadest of general testing categories, includes paying contracted rates, out-of-network limits, cost containment provisions of contracts, and modifier discounts
Findings often relate to retroactive terminations, errors in transmitting eligibility information, can also include dependent eligibility verification for client who engage this service along with claims audits
Detailed coding rules such as unbundled procedures, mutually exclusive procedures, unit count errors, diagnosis and procedure mismatch
JGI offers exceptional medical claims audits customized to each client’s unique needs. With highly flexible audit scope and pricing methodologies, we ensure that every employer group has an opportunity to take advantage of our experience and expertise. JGI stands out for our commitment to customer service and direct return-on-investment for our clients.
PBM Audits are powerful tools in better understanding this significant source of plan costs, and in our experience most result in both money due back to the plan sponsor and recommended changes for future cost reduction. Many audits offered in the pharmacy market are really just pricing analyses conducted for the purpose of trying to secure the brokerage account for the employer. While these assessments offer value, we built our PBM audit platform to truly test the accuracy of claims payments with the same comprehensive Audit Process as our medical plan audits.
What makes dental audits by JGI particularly effective is our experience with industry standards and detailed benefits testing. Rarely do dental audits uncover significant dollar amounts of errors, but they often find multiple benefits that are either not properly set up or are applied manually with high error rates. The fact that we do not use any dollar value cutoffs in our approach and our willingness to test every benefit possible result in successful, comprehensive dental audits conducted with the same approach and care as medical audits.
We take the time to understand client priorities and develop a communication strategy and customized materials that fit each client’s culture. Clients find that our approach to this portion of the project is much more customized and hands-on than the industry norm, though our pricing remains competitive and our performance guarantees exceed expectations.
John worked closely with us to understand our specific claims audit requirements, bringing JGI’s expertise to the table, making for a better review process. Their team was very thorough, and the output was exactly what we were looking for. Several opportunities for improvement were identified, and we could not be more happy with the results. We expect to engage with JGI again in the future.