Out-of-network charges run amok
JGI found in a recent audit that our client’s TPA was paying significantly more for out-of-network claims than the plan’s benefit allowed. The TPA was running claims through a rental network, usually for small percentage of charge discounts, but was... Read More →
In 2015, JGI was proud to donate a portion of our revenues to Siloam Family Health Center and Faith Family Medical Center. We set a goal from the founding of our company to give annually to causes selected by our... Read More →
Claims Audits Are NOT a Software Solution
I have been asked many times in my 16-year career in claims auditing about the software that we utilize to perform our work. The fact is that it is easier to understand our job as a black box program that... Read More →
Will I need another audit if the TPA fixes everything from the first one?
Operational improvements at the TPA are a frequently overblown promise in the claims audit market. We commonly see proposals that promise that the claims audit vendor will ensure that the TPA fixes everything that caused errors. The first problem with... Read More →
Evaluating Claims Audit Vendors
Shopping for a claims audit is difficult, given the limited exposure to claims audits topics for most employers. Some common issues to pursue in evaluating proposals include: What is the scope of your auditing process? Claim audit firms couch their... Read More →
Why Do I Need a Claims Audit?
The healthcare industry is a sloppy one and costs are constantly on the rise. Industry studies show that overpayments are 1-3% of total expenses, not including fraud. Self-insured employer healthcare plans are complicated. They often include highly customized benefits. Many... Read More →
Core Values: Flexibility
Companies often are simply hard to deal with. Accountability and decision-making are spread thin, requirements are set that are difficult to understand, and then legal gets involved on top of that. At J. Graham Inc., we understand that the last... Read More →