Timing Matters in Medical Claim Audits
The role of medical claim auditors is to assist clients, typically self-funded medical and pharmacy plans, in identifying errors. These mistakes can arise from human error or systemic issues, but either way, they can accumulate quickly, especially in larger plans and during unexpected events like the recent COVID-19 pandemic. With significant financial implications at stake, even the performance guarantees from leading third-party claim administrators may not suffice. Conducting a comprehensive audit that scrutinizes every claim payment is the most effective approach, and it's the most efficient.
Engaging an independent auditing firm for your claim review can enhance the likelihood of flagging all errors and implementing systemic improvements. Specialist firms bring knowledge and a fresh perspective to your claim data, knowing where to focus their efforts. Their experience with similar plans equips them to provide valuable insights into yours. Utilizing both thorough and efficient proprietary software makes a significant impact, as…
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