No one is surprised to find out the coronavirus pandemic profoundly impacted medical and pharmacy benefit plans. For large employers that self-fund their plans, the budgetary impacts were historic and upended utilization rates. Medical claims auditing is the management tool most plan sponsors are using in the aftermath as they check for overcharges, payment errors, dispensing mistakes, and much...

The goal of every medical plan is to pay claims accurately and with consistency according to the plan documents for covered services. But with most self-funded plans now outsourcing claim payments to third-party administrators, there needs to be oversight to make sure things go as planned. It's where medical bill auditing services come in as they review the work of TPAs to check for...

With the never-ending increases in health care costs, self-funded medical plans must explore ways to manage expenses. Medical claims auditing is increasing because it is revenue neutral (or better). More specifically, 100-percent claim auditing of medical and prescription medicine plans usually pays back the audit cost as much as four times over. It's earned the notice of managers overseeing...

By now, nearly all medical plan sponsors have concluded that health plan auditing services can save them money and improve their member service. Therefore it's logical to accept that continuous monitoring on the same audit software has the same potential. With claims processing nearly always outsourced these days, the oversight of an audit is a plan's best defense against costly errors and...

In the early days of self-funded health plans, audits were looked on as a regulatory requirement rather than a plan management opportunity. But things have changed, and plan managers understand that medical bill auditing services play a crucial role in excellent plan management practices. Most claims today are paid by third-party administrators (TPAs), which means there is a need for...

The mission of every health plan, including those self-funded by large employers, is to serve members well and provide the care they need. But they are also large and complex financial undertakings that can bring significant financial issues when not closely managed. It's why medical claims auditing is on the front burner, especially since the coronavirus brought a spike in utilization rates....

Large employers care for their employee's health care needs with self-funded plans for sound financial reasons. But those plans need medical claim audits frequently to stay on track. In the early days, when audits relied on random samples that were less accurate, they were used for regulatory compliance. But today, they are a valued management tool, and auditors check 100-percent of claims paid...

The coronavirus pandemic was a wake-up call to many health, and pharmacy benefit plan sponsors about how quickly costs can skyrocket. It thrust health plan auditing services into the spotlight as never before and did the same for pharmacy claim audits. But there are very different opportunities for error detection and correct leading the recovery of funds for each plan. Therefore,...

Years ago, self-funded medical plans relied on random samples when auditing claims, and there was an accepted level of accuracy that was far from perfect. But when technological advances in audit software brought significant improvements, auditing suddenly went from regulatory compliance to a strategic management tool. The leap ahead was the advent of 100-percent claim audits that reviewed...

Demands for accuracy and accountability are rising these days, and the expectations for self-funded health plan performance are no exception. You can see why medical claims auditing is increasingly called on to confirm the accuracy of claim processing and plan performance overall. The trend among self-funded plans to outsource claim payments had increased the need for oversight since the...