Claims auditing is all we do, and our relentless staff has the breadth and depth of experience to find errors and help you recover your losses.
The typical ROI for our clients is 300-400%, and that doesn’t include future savings. We have achieved a 100% success rate with some of the largest employers in the country.
Clients simply give us a pdf of their plan documents and we do the rest. And we make sure our work fits each client’s unique needs to eliminate hurdles and headaches.
Error rates in healthcare range from 1-3%. Our proprietary, painless claims audit platform uses an automated system to identify more issues, more quickly, focusing on:
Patient portions, benefit limits, noncovered services
Traditional duplicate claims, duplicate lines, overlapping inpatient claims
Missed coordination opportunities and errors with Medicare, commercial and secondary plans
Contracted rates, out-of-network limits, cost containment provisions, modifier discounts
Retroactive terminations, errors in eligibility information, dependent eligibility verification
Detailed coding rules including unbundled procedures, mutually exclusive procedures, unit count errors, diagnosis/procedure mismatch
Highly flexible medical claims audit scope and pricing options customized to each client’s unique needs.
Powerful tools to better understand this significant source of plan costs, built to truly test the accuracy of claims payments.
Comprehensive benefits testing guided by our experience with industry standards to identify errors in setup and application.
Up to 8% of dependents are ineligible for coverage for a variety of reasons — our audits help plans operate more efficiently.
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 happier with the results. We expect to engage with JGI again in the future.