To better manage their self-funded benefits plans, and comply with regulatory requirements, companies need independent medical claims auditors. Firms that specialize in benefits plans audit without linking them to other services are among the most trustworthy. Their independence assures a complete focus on the client company’s best interests – improving claims administration to save money and better serve the employee-beneficiaries. Thanks to technological advances and increased experience, every year, the best firms move the industry ahead. The rising cost of medical care makes mistakes, not an option.
If you’re in a plan management role at a mid or large-size company, finding an independent medical claims auditor with a full-service approach is optimal. Also, keep an eye out for an auditor that reviews 100-percent of claims rather than a random sample. A two-pronged approach that includes a complete electronic audit followed by a manual review ensures the most accurate results. When every claim is reviewed, there is also a significantly improved opportunity to identify error patterns that can be eliminated going forward. The potential for cost savings year after year will add up considerably.
Claims auditors that are never content with the status quo and push the industry forward are the ones with the best grasp of continuing advanced in technology. They serve their clients well and operate in a manner that is budget neutral and often produces savings far higher than the original audit cost. Such firms are consultants to company management and advocates on their behalf with administrators. The process improvements and efficiency gains can be beneficial to administrators in the long run. An error-free process benefits everyone with cost efficiencies and produces better results for all.
Independence and reliability – along with protecting the security of a client company’s data – are the best claim auditors’ hallmarks. Expert firms often view medical claims auditing as their core business and extend out to cover claims administration for all employee benefit plans. When there are regulatory requirements for plan audits, they have the expertise to meet a company’s needs. The advent of self-funded medical plans administered by third parties created a demand for audit oversight at a high level of accuracy. It produces millions of dollars in savings for large companies every year.