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Posted on May 29, 2024 at 1:26am 0 Comments 0 Likes
Posted on February 26, 2024 at 11:35pm 0 Comments 0 Likes
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…
ContinuePosted on February 15, 2024 at 11:49pm 0 Comments 0 Likes
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…
ContinuePosted on January 31, 2024 at 11:30pm 0 Comments 0 Likes
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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