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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The modern pharmaceutical industry, with billions in profits on the line, strongly advocates for its self-interests. The industry's investment in research and development is cited as the reason for high costs, but profits are also built into the equation. An Rx audit is one defense against skyrocketing prices for self-funded healthcare plans. Companies routinely offer rebates and discounts to hold market…

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Costs increase for large employers funding their medical and pharmacy plans each year. Therefore, it's crucial to double-check claim payments routinely with a healthcare audit to assure accuracy. Outside administrators, these days, often drive error rates to impressively low single digits, but confirming their accuracy always matters. Also, when you work with experienced claim auditors, they bring knowledge to the… Continue

People in many technical fields speak a language all their own, but it can diminish the value of their work when communicating outside their specialty area. With medical claim auditing, concise and easy-to-read reports increase the value of the audit and the ease of taking action on its findings. Improved technology covering 100 percent of claims processed helps electronic reviews find and flag more irregularities than random… Continue

Medical and prescription medicine costs rise continually, and each year that makes a healthcare claims audit more beneficial. Large employers that self-fund plans have a vested interest in accuracy, and most outsource their claim administration to third parties. Routine oversight is therefore crucial as plan sponsors want a greater comfort level and control over their cash outflows. Many times claim administrators hit…

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When a health care claim processing system is set up, building it with an eye to simplicity and ease of auditing is a wise idea. With medical claims auditing of value to providers and heal plans alike, it's becoming a more frequently used management tool. Therefore, having a more accessible system for audits makes sense. Accurate coding is often at the heart of medical claim errors. It costs plans extra money and…

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Implementation auditing is essential 90 days after new health and pharmacy claim processing set-ups. It's also accurate medical claim auditing services can independently verify that third-party administrators and pharmacy benefit managers have their systems set up correctly. It's the way to catch minor errors before they become million-dollar problems. TPAs and PBMs famously offer performance guarantees, but only…

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