Industry Thoughts

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 →

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 →

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 →

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 →