If you're the person at your company responsible for managing a self-funded medical plan, you owe it to yourself – and your company – to find out more about a continuous claims monitoring service. When it comes to medical claims reviews, it can't be beaten in terms of accuracy. Too many plan managers rely on the required audits to double-check their claims administrators (often large health insurance carriers). While 100-percent claim audits find all errors, they can't catch problems early before they become significant. Also, it's tougher to recoup overpayments than it is to prevent them.
The continuous claims monitoring service is a natural follow on to a 100-percent claims audit. The combination produces vastly superior accuracy to an old-fashioned random sample audit. The great advantage of continuous monitoring is actionable data reported in real-time. There always will be claims administration errors in large plans, and many times the same error repeats until it becomes a significant problem. Continuous claims monitoring catches issues early on and allows you to address them with your administrator quickly and with factual data. It lets you manage a plan better than ever before.
If cost management and containment are significant priorities for your company, the combination of a 100-percent audit and continuous claims monitoring is essential. Catching frequent (and common) errors such as filling prescriptions with expensive name-brand medications when generics are available can help your plan operate on a budget. Also, many other efficiencies are uncovered by monitoring so that administrators handle claims according to plan agreements. When there is not careful oversight, it's typical for a significant lapse in administering according to what was agreed on.
What also crucial is to work with a detail-oriented claims monitor and auditor. Only a precise approach that reviews 100-percent of claims will bring the maximum cost benefit to your company. Also, both services, audits, and monitoring are budget neutral, if not better. The savings they uncover will cover the audit cost and, many times, return savings even more extensive than the price charged. It allows you to fulfill your legally required audit and do a much better job managing your claims processing. It's all thanks to continuous advances in technology leveraged by firms with a commitment to accuracy and quality.
