Claim Audits Bring Powerful Oversight

If there's one thing that's certain about medical claims auditing , it provides oversight that's second to none. Employer-funded health plans pay millions of dollars in monthly claims, and keeping tabs on the administrators making the payments is essential. Auditors with experience in the field know where to look for errors, and they also check based on your plan's provisions – each plan covers different items with specific parameters. Indeed, claim processing accuracy has markedly improved in recent years, but oversight remains necessary. Auditors have expertise that adds value to their work.

The proper pre-audit setup is crucial and includes zeroing in on your plan's covered services and medicines. Most third-party claim administrators are large health and pharmacy benefit management plans with their own systems and lists of covered items. You can piggyback on their arrangement to a large extent, but it may also have…