Last Updated:
January 18, 2024

Posts tagged "medical benefits plan auditing"
Per Page :

Minor Errors Add Up in Claim Payments

Every medical claim paid is a complex endeavor. One way for employer-funded plans to police the accuracy of their payments is a healthcare audit. Reviewing each payment made by a third-party administrator or pharmacy benefits manager is a crucial oversight function. Catching and correcting significant error patterns is vital, but so is finding individual mistakes. Taken together, minor errors add up to substantial sums for many plans, and flagging and correcting them makes a difference. It supports cost containment efforts and improves member service when claims are paid correctly with consistency. The audit setup is one of the most crucial parts of the process because everything flows from it. A one-size-fits-all approach won’t yield the benefits of a customized configuration. The nuances of each plan need to be addressed by the audit software, ideally by someone with equal expertise in medical claims and audit techniques. It’s why all claim auditors aren’t alike, and selecting the best makes a difference. They bring years of expertise and a specialized approach that adds value. There is no substitute for working in the field daily, staying current with trends, and continuously improving. As claim audit technology and systems become more sophisticated, the electronic portion of […] read more
0 Views : 10

Minor Errors Add Up in Claim Payments

Every medical claim paid is a complex endeavor. One way for employer-funded plans to police the accuracy of their payments is a healthcare audit. Reviewing each payment made by a third-party administrator or pharmacy benefits manager is a crucial oversight function. Catching and correcting significant error patterns is vital, but so is finding individual mistakes. Taken together, minor errors add up to substantial sums for many plans, and flagging and correcting them makes a difference. It supports cost containment efforts and improves member service when claims are paid correctly with consistency.   The audit setup is one of the most crucial parts of the process because everything flows from it. A one-size-fits-all approach won’t yield the benefits of a customized configuration. The nuances of each plan need to be addressed by the audit software, ideally by someone with equal expertise in medical claims and audit techniques. It’s why all claim auditors aren’t alike, and selecting the best makes a difference. They bring years of expertise and a specialized approach that adds value. There is no substitute for working in the field daily, staying current with trends, and continuously improving.   As claim audit technology and systems become more sophisticated, the […] read more
0 Views : 14