Large employers often self-fund their benefit plans for various, including financial advantages. However, the costs associated are substantial and can vary significantly based on external factors. As a result, effective oversight, such as a health plan and Rx audit, is a vital consideration for plan sponsors. One of the most impactful methods for examining expenditures and ensuring that claim payments align… Continue

With outsourced administrators paying millions of dollars in claims a week for employer-funded health plans, active oversight of their work is essential. It’s why plan sponsors routinely use medical claim auditing services to review their payments. Regardless of the era or circumstances, claims audits prove their value in myriad ways – the most recent example was the coronavirus pandemic. When utilization and…

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When large corporate or nonprofit employers sponsor their employee benefits, they put millions of dollars on the line. Healthcare plans are among the most expensive, and it's why medical claims auditing and pharmacy claim reviews matter so much. There is a fiduciary responsibility to pay claims accurately, and with outside firms handling it, auditing is the most effective way to conduct oversight. It provides an…

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The pricing structure for the pharmaceuticals paid for by employer-sponsored health plans often includes rebates and discounts. They can be deducted from the prices paid or credited later. In either case, tracking them across thousands of transactions is challenging, and an Rx audit can help. With their sophisticated systems, claim auditors can review thousands of transactions for accuracy and report on…

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