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Benefit plan claim payments, especially costly ones for health plans, need active oversight to watch for errors. Prescription and medical claims auditing is an excellent way to double-check payment accuracy and the work of claim administrators – third-party processors and pharmacy benefit managers. When   large employers self-fund benefit programs and outsource claim administration, there is significant financial exposure. In at least two recent instances, large corporations have gone to court agai... more

Employers covering benefits for their employees do so to attract and retain good talent. But the costs of benefit programs, especially medical and prescription drug coverage, continually increase. As self-funded plans struggle to contain costs, healthcare auditing companies can help. Their careful review of claim payments can flag costly errors and help prevent similar ones from occurring in the future. Their contribution to cost management has increased as technology has improved so that audits review 100 percent of claims paid. As ... more

Periodic audits are a must for the benefit plans offered by large employers, both corporate and nonprofit. Depending on the employee population, claims paid in error can cost hundreds of thousands or millions of dollars. Medical claims auditing and similar doublechecks of pharmacy benefit plans are budget-friendly. They lead to recoveries far more than the audit cost, sometimes up to four times as much. Another meaningful asset is having people on the audit team with knowledge of claim payments from inside large health carriers t... more