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 on manual review by processors to catch errors and unprogrammed benefits. As a result, mistakes happen regularly.

Businesses are exposed to risk using a third party administrator, who often writes checks from your account with no reconciliation Throughout the claims process, no one but the employer has an incentive in avoiding overpayments or finding those that occur. Who will protect your interests if you don’t perform an audit?

The financial leakage is often small and subtle, but it adds up. Average recoveries from a comprehensive audit are ½ to 1% of the total cost of your healthcare plan. By performing root cause analysis on these errors, we minimize future errors to the highest extent possible. Combining quality improvement with direct recoveries from overpayment correction offers an outstanding return on investment.

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