JGI Blog

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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 ignoring the UCR limits of the plan. The result was...
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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 employees. For JGI, this feels like the right thing for...
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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 spits out errors than one which requires constant time, attention...
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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 actual scope in lots of verbose language, but the important...
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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 TPAs have difficulty programming these custom plans and often rely...
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