Founded by expert healthcare auditors, J. Graham Inc. offers custom, comprehensive auditing services that produce results, including medical, dental and pharmacy audits. Based in Nashville, we travel all over the country conducting claims audits. Our practice is truly national in scope with no geographic or industry focus other than self-insured employers. Our infrastructure and audit approach is built to handle any size employer group and any Third Party Administrator or Pharmacy Benefits Manager utilized.
Our goal with every audit is to recover lost expenses that you are entitled to. Error rates in healthcare range from 1-3%, not including fraud. Moreover, third party administrators never offer 100% claims accuracy. The truth is, claims administrators hire vendors directly to find and recover lost expenses on their fully insured accounts when it is their money at risk. Errors are expected in this industry, and your business needs this same level of protection. Our claims audit will find and recapture some of those lost expenses.
Our track record is exceptional – 100% success rate with some of the largest employers in the country. J. Graham Inc.’s staff of experts have audited every major carrier, including Aetna, Anthem, Cigna, Humana, Meritain, Optima, United Healthcare, UMR and practically every Blue Cross Blue Shield plan in the country.
Our professionals have experience auditing healthcare plans with annual expenses ranging from $3 million to $5 billion, using varying audit approaches that include random sample, targeted and comprehensive. Every size business benefits from our claims audit services.
We deliver on our promises. We say what we mean and our services back it up. Our proposals include accurate error projections and realistic timelines, and we will gladly explain any parts you don’t understand. Our flexible approach ensures that companies have the fewest hurdles to achieving results from our claims audit services. Our flexible scope, pricing, contracts, and data layouts make it easy for companies to work with us.