Thorough and scrupulous medical claims auditing is essential to the performance of self-funded corporate medical plans. It's a regulatory requirement and a necessary part of good plan management. Independent auditors who focus solely on medical claims reviews have the best track record of outstanding performance. They have the expertise required and have no agenda other than making sure their clients' plans operate at peak performance. A well-run plan serves its members better and contains costs. With medical expenses skyrocketing every year, careful plan management is vital.
For anyone who manages a self-funded health plan for a mid- or large-size company, finding an independent auditing firm specializing in claims review is essential. When an audit is not tied to any other program or schedule, it is unbiased and devoted to plan improvement. Catching and correcting mistakes, as well as preventing future errors, are the most important benefits. Wise plan managers also opt for auditors using a 100-percent review method. It assures that all claims are reviewed, and errors are reported in a level of detail not caught in random sample audits. It improves audit quality overall.
Independent auditors with integrity and a healthy rebellion against the status quo are among the most desirable. They take pride in their work and go out of their way to review every claim with an infallible level of accuracy. They understand what is on the line for companies financially with self-funded medical plans – and are well-versed in the kinds of errors claims administrators make most often. For example, they may allow costly name-brand prescriptions to be filled when lower price generic equivalents are available. Picking up these small details consistently makes a considerable difference in the long run.
Data security is of the utmost importance, and the best independent medical claim auditing companies have built-in safeguards. Their security precautions extend from electronic access limits to security for their offices and server facilities. Your employee's personal medical information is highly confidential, and audits must protect it above all else. The finest independent auditors take the need for these precautions seriously. When you're interviewing firms to audit your plan's claims, make asking for a summer of security precautions in place. Top-notch auditors are ready to provide one.