Some organizations are required by law to audit healthcare claims, and unfortunately, 
some may just select the lowest priced vendor in order to “check the box” and say they did their duty. However, there are other considerations to take into account besides the initial cost of an audit.
- Vendors who charge less may not truly perform comprehensive audits.
Our 100% Difference comprehensive audit reviews every healthcare claim. Healthcare Horizons does not limit our audits to “low hanging fruit” or to only those claims paid above a certain threshold. We pride ourselves in examining areas that other audit firms do not question. Finally, we customize each audit to the specific benefits offered by our clients. This approach yields better results because we identify both isolated and systemic errors and assign actual dollar impact to those errors, making a much stronger case to the payer. As a result, our clients can correct systemic issues, preventing future claims paid in error.
- Vendors who charge less may not have the experience you would want.
Everyone has a computer, but not everyone has the required experience to know what they are looking for. When you are auditing potentially millions of transactions, it is helpful to have a team of eyes on those transactions with many years of experience identifying and correcting claims errors. Software and search technology are amazing innovations, but they do not replace the kind of experience and knowledge that we bring to the audit process.
- Vendors who charge less may not focus on the personal relationships that remind you that your company matters.
Audits should always include an onsite visit to properly determine your organization’s unique needs and goals. Healthcare Horizons works WITH you to put People First. We respect your TPA relationship, we keep you informed so that you can make recovery decisions with an understanding of member impact, and you receive hands-on involvement from our leadership with every audit. We ensure that YOU are in charge. You determine which claims to recover, and you decide how hands-on you want to be.
- Healthcare Horizons offers contingency audits.
With a contingency audit, you incur no costs until you recover the overpaid claims we find. This approach offers your company a risk-free way to fulfill your fiduciary responsibility to your employees and stakeholders and “check the box” in a manner that provides the most benefit and ensures future savings.
The Difference is in Knowing.
Visit Healthcare Horizons today to learn more, or contact us at hhadmin@healthcarehorizons.com to discuss a healthcare claims audit assessment.
Randy King is president of Healthcare Horizons Consulting Group, Inc., which has performed healthcare claims audits since 1999. Trusted partner. Uncompromising accuracy. Superior personal service. Recovering millions of dollars for some of the world’s largest employers.