Large corporate and nonprofit employers self-fund their benefit plans for many good reasons. It also means running oversight on their expenditures, including medical claim audits, is essential. When you consider the dollars on the line, made even more apparent by the recent coronavirus pandemic expenses, it's easy to understand why running oversight on costs and payments is crucial. Outsourcing claim administration to third-party processors has many reasonable justifications, financial and otherwise. But it also means an outside contractor controls significant cash outflow.
Claim auditing has gone from regulatory and compliance territory to a valuable plan management tactic. It's thanks in large part to advances in systems and software. What used to be a random sample process involving notable staff time has become a primarily electronic review. Powerful proprietary software provided by claim audit firms and many specialists in the field has changed the game. It's now routine to check 100 percent of claims rather than small bunches in random selections. Error trends and processing errors quickly become evident and can be corrected. It has saved many plans from overpaying.
When you consider what's at stake for health and pharmacy benefit plans, members' care, and millions of dollars, you quickly see why claim audits are crucial. They are the best way to review the plan administrators' work and accuracy. Undoubtedly, most self-report that performance and their data may be accurate. However, an independent claim audit is the only way to confirm it. When you work with specialist auditors who review claims daily, they know where to look. It also helps when they carefully program your plan's provisions into claim audit software for specialization.
One of the best things about settling on an auditor that serves your needs well is continuity. A clear trend emerges when you can compare your claim payment accuracy year-to-year. It also puts you in good shape to quickly detect changes or irregularities. If the coronavirus pandemic taught health plan managers anything, it is that sudden, unexpected events can occur that upend budgets and annual plans. Health and pharmacy plans that had in place existing audit relationships fared much better as they managed their way through unprecedented costs. They emerged stronger and still on firm footing.
Company Name- TFG Partners, LLC
New Address- 437 Grant St #1020, Pittsburgh, PA 15219
Contact Number- (412)-281-2228
No comments yet